PDF(Pubmed)
Abstract：
BACKGROUND: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).
METHODS: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.
RESULTS: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).
CONCLUSIONS: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.
METHODS: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.
RESULTS: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).
CONCLUSIONS: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.
摘要：
背景：接受抗凝和抗血小板药物治疗的老年创伤患者的比例最近一直在上升。随着新代理的引入，每个都有自己的优点和预防措施。我们的研究涵盖了接受抗凝（AC）或抗血小板治疗（APT）的颌面部创伤的ED老年患者。我们的目的是调查人口统计学特征，原因,以及颌面部创伤的类型，伴随着受伤，住院时间，出血性并发症，以及急诊科（ED）的整体护理费用。
方法：数据来自伯尔尼大学医院的ED。在这个回顾性分析中,包括65岁以上的患者，他在2013年至2019年期间接受了治疗性AC/APT治疗时在我们的ED上接受了颌面部创伤。
结果：该研究涉及188例患者，中位年龄为81岁（IQR：81[74;87]），其中55.3%(n=104)为男性。超过一半（54.8%，n=103）年龄在80岁以上。69.7％（n=131）的患者存在心血管疾病，使用AC/APT最常见的适应症是既往血栓栓塞事件（41.5%，n=78）和心房颤动（25.5%，n=48）。面部受伤的主要原因是跌倒，占病例的83.5%(n=157)，其次是自行车事故(6.9%，n=13)和道路交通事故(5.3%，n=10)。最常见的原发性损伤是眶底和/或内侧/外侧壁骨折（60.1%，n=113),颧骨（30.3%，n=57),其次是孤立的眶底骨折(23.4%，n=44）和鼻骨骨折（19.1％，n=36）。下颌骨骨折发生率为14.9％（n=28）。68.6%的患者(129例)发生面部血肿,主要在中脸区域。相关的面部出血并发症是脑出血最常见(28.2%，n=53),其次是鼻出血(12.2%，n=23）和球后/眶内血肿（9％，n=17）。16例患者（8.5％）经历了需要紧急治疗的大量出血。住院死亡率为2.1％（4例）。
结论：这项研究表明，跌倒是老年人颌面部创伤的主要原因，最常见的诊断是眼眶，颧骨,和鼻骨骨折.出血并发症主要涉及面部血肿，尤其是在脸的中间三分之一，脑出血是第二常见的。8.5%的病例需要手术干预出血。鉴于人口老龄化,改进预防策略和更新安全协议至关重要，特别是抗凝/抗血小板治疗（AC/APT）的患者。这可以确保在紧急情况下快速诊断成像和及时治疗。
方法：数据来自伯尔尼大学医院的ED。在这个回顾性分析中,包括65岁以上的患者，他在2013年至2019年期间接受了治疗性AC/APT治疗时在我们的ED上接受了颌面部创伤。
结果：该研究涉及188例患者，中位年龄为81岁（IQR：81[74;87]），其中55.3%(n=104)为男性。超过一半（54.8%，n=103）年龄在80岁以上。69.7％（n=131）的患者存在心血管疾病，使用AC/APT最常见的适应症是既往血栓栓塞事件（41.5%，n=78）和心房颤动（25.5%，n=48）。面部受伤的主要原因是跌倒，占病例的83.5%(n=157)，其次是自行车事故(6.9%，n=13)和道路交通事故(5.3%，n=10)。最常见的原发性损伤是眶底和/或内侧/外侧壁骨折（60.1%，n=113),颧骨（30.3%，n=57),其次是孤立的眶底骨折(23.4%，n=44）和鼻骨骨折（19.1％，n=36）。下颌骨骨折发生率为14.9％（n=28）。68.6%的患者(129例)发生面部血肿,主要在中脸区域。相关的面部出血并发症是脑出血最常见(28.2%，n=53),其次是鼻出血(12.2%，n=23）和球后/眶内血肿（9％，n=17）。16例患者（8.5％）经历了需要紧急治疗的大量出血。住院死亡率为2.1％（4例）。
结论：这项研究表明，跌倒是老年人颌面部创伤的主要原因，最常见的诊断是眼眶，颧骨,和鼻骨骨折.出血并发症主要涉及面部血肿，尤其是在脸的中间三分之一，脑出血是第二常见的。8.5%的病例需要手术干预出血。鉴于人口老龄化,改进预防策略和更新安全协议至关重要，特别是抗凝/抗血小板治疗（AC/APT）的患者。这可以确保在紧急情况下快速诊断成像和及时治疗。
