Spotlight on Research

Older adults with head injury are a challenging group of patients to the ambulance clinician. Older age, clinical frailty, comorbidities, anticoagulant and antiplatelet medications can contribute to these patients suffering a traumatic intracranial haemorrhage (tICH). However, unlike younger adults, older adults can suffer significant tICH without displaying symptoms, which can make identification and triage of these patients challenging.

Head injury guidelines are available to ambulance clinicians. However, the evidence they are built on is biased towards young, symptomatic patients with head injury, not older asymptomatic patients. Furthermore, anticoagulant medications are considered a red flag, regardless of whether the patient has no other symptoms; some paramedics find this restrictive to practice.

This study carried out by Barrett et al aimed to determine if sufficient information was available to an ambulance clinician to identify older adults at risk of a tICH and explore what factors determined whether an older adult with a head injury was conveyed or non-conveyed to the emergency department (ED). Data from older adults presenting to one ambulance service in the UK with a head injury in 2020 were included.