Diagnosis and Prognosis for Traumatic Brain Injuries in the Elderly

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Recommended: Falls among the elderly population in the hospital setting

Following a fall two weeks ago in which Betty hit her head on a table, Betty sustained a 4cm haematoma. The fall appears to have resulted in a traumatic brain injury (TBI); given the information it would appear as though Betty may have an external haematoma, cerebral contusion and intracranial haemorrhage.
Injuries related to falls costs Australia's health care system more than any other injury. It is expected that over 25% of Australia's elderly population (65 and over) are likely to have a fall. Falls account for over 50% of traumatic brain injuries in people over 65 (NSW Government; Population Health, 2011). The number of risk factors for a fall increases with age, therefore making the elderly population more susceptible to having a fall (Thompson, McCormick, & Kagan, 2006). In Betty's case the mechanism of injury is a vertical deceleration. Betty tripped on a mat and hit her head on a table, as she hit her head this would provide the coup mechanism causing the brain to strike the front of the skull, the countercoup motion is the motion of the brain being thrust into the back of the skull (Medicallegalart, 2011).
The pattern of injury refers to the pathophysiological changes that occur after the injury. Given Betty's deterioration in the fifteen minutes between the initial vital sign survey and the second, in light of Cushing's reflex, it is possible that Betty's fall has caused a cerebral haematoma and her intracranial pressure (ICP) is rising. Cushing's reflex is the hypothalamic response to an increase in intracranial pressure, and increase in intracranial pressure causes poor perfusion and brain ischemia, resulting in an altered level of consciousness. The reflex results in the clinical symptoms of Cushing's triad, which...

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...14, from http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/swcavhct/$File/swcavhct.pdf
Thompson, H. J., McCormick, W. C., & Kagan, S. H. (2006). Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications: TRAUMATIC BRAIN INJURY AND OLDER ADULTS. Journal of The American Geriatrics Society,54(10), 1590-1595. doi:10.1111/j.1532-5415.2006.00894.x
Tien, H. C., Cunha, J. R., Wu, S. N., Chughtai, T., Tremblay, L. N., Brenneman, F. D., & Rizoli, S. B. (2006). Do Trauma Patients with a Glasgow Coma Scale Score of 3 and Bilateral Fixed and Dilated Pupils Have Any Chance of Survival? Journal of Trauma-injury Infection and Critical Care, 60(2), 274-278. doi:10.1097/01.ta.0000197177.13379.f4
Tintinalli, J. E., Cline, D., & American College of Emergency Physicians (2012). Tintinalli's emergency medicine manual. New York: McGraw-Hill Medical.

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