Acil Servise Başvuran 65 Yaş ve Üzeri İntrakranial Kanaması Olan Hastaların Demografik ve Epidemiyolojik Özelliklerinin Analizi

Year 2025, Volume: 51 Issue: 1, 119 - 124, 27.05.2025

Tuğçe Yeni , Ozlem Koksal , Vahide Aslıhan Durak , Göksel Aydoğan , Ömer Yontar , Nur Betül Coşkun

https://doi.org/10.32708/uutfd.1565789

Abstract

Bu çalışmanın amacı acil servise başvuran ≥65 yaş intrakranial kanaması olan hastaların demografik ve epidemiyolojik özelliklerinin incelenmesi ve klinik sonlanımları ile ilişkili faktörlerin belirlenmesidir. Kesitsel tipte olan bu çalışma, 1 Ocak 2018 – 31 Aralık 2022 tarihleri arasında acil serviste intrakranial kanama tanısı alan ≥65 yaş olguların dosyalarının retrospektif olarak değerlendirilmesi ile gerçekleştirilmiştir. Olguların %57,6’sı erkekti ve yaş ortalaması 75,49 ± 7,43 yıldı. Olguların %79,9’unda en az bir ek hastalık, %46,0’ında travma öyküsü vardı. Bilgisayarlı Tomografi sonucunda en sık saptanan kanama türleri %39,1 subdural, %38,6 intraparankimal ve %26,1 subaraknoid kanama idi. Klinik sonlanım açısından bakıldığında; olguların %7,6’sının acil servisten taburcu edildiği %21,2’sinin yoğun bakım ünitesine yatırıldığı, %29,9’unın dış merkez yoğun bakım ünitesine sevk edildiği ve %1,6’sının ise exitus olarak sonlandığı görüldü. Diğer olgularla karşılaştırıldığında, klinik sonlanımı olarak yoğun bakım ünitesi yatış/ sevk/ ölüm olan olgular arasında kadın cinsiyet sıklığı ve subdural kanama sıklığı istatistiksel olarak anlamlı düzeyde daha yüksek iken; Glasgow Koma Skoru ve intraparankimal kanama sıklığı ise anlamlı düzeyde daha düşüktü. Sonuç olarak klinik pratikte özellikle kranial BT’de subdural hematom saptanan ve GKS skoru düşük yaşlı intrakranial kanamalı olgularda kötü sonlanım riskinin daha fazla olduğunu göz önünde bulundurularak, erken dönemde doğru tedavinin uygulanmasının sağ kalımı artıracak çabalar arasında yer alacağı düşünülmektedir.

Keywords

acil servis , Glasgow Koma Skoru , intrakranial kanama

Analysis of Demographic and Epidemiologic Characteristics of Patients 65 Years and Older with Intracranial Hemorrhage Presenting to the Emergency Department

Abstract

The aim of this study is to examine the demographic and epidemiological characteristics of patients with intracranial hemorrhage aged ≥65 years who applied to the emergency department and to determine the factors associated with their clinical outcomes. This cross-sectional study was conducted by retrospectively evaluating the files of patients aged ≥65 years who were diagnosed with intracranial hemorrhage in the emergency department between January 1, 2018 and December 31, 2022. 57.6% of the cases were male, and the mean age was 75.49 ± 7.43 years. In 79.9% of the cases, there was at least one comorbidity, and 46.0% had a history of trauma. The most frequently identified types of hemorrhage on Computed Tomography were 39.1% subdural, 38.6% intraparenchymal, and 26.1% subarachnoid hemorrhage. In terms of clinical outcomes, 7.6% of the cases were discharged from the emergency department, 21.2% were admitted to the intensive care unit, 29.9% were transferred to an external center’s intensive care unit, and 1.6% resulted in death. Compared to other cases, among those with intensive care unit admission/transfer/death, female gender and subdural hemorrhage were statistically significantly higher, while Glasgow Coma Score and intraparenchymal hemorrhage frequency were significantly lower. In conclusion, considering that in clinical practice, the risk of poor outcome is higher in elderly patients with intracranial hemorrhage, especially those with subdural hematoma detected on cranial CT and with low GCS scores, it is thought that the implementation of treatment modalities in the early period will be among the efforts to increase survival rate.

Keywords

emergency department , intracranial hemorrhage , glasgow coma scale

References

• 1. Caceras JA, Goldstein JN. Intracranial Hemorrhage. Emerg Med Clin North Am. 2012;30(3):771-94.
• 2. An SJ, Kim TJ, Yoon BW (2017). Epidemiology, Risk Factors and Clinical Features of Intracerebral Hemorrhage: An Update. J. Stroke 19 3–10. 10.5853/jos.2016.00864 [
• 3. Nemcek, J., Jakubicek, R., Chmelik, J. (2021). Localization and Classification of Intracranial Hemorrhages in CT Data. In: Jarm, T., Cvetkoska, A., Mahnič-Kalamiza, S., Miklavcic, D. (eds) 8th European Medical and Biological Engineering Conference. EMBEC 2020. IFMBE Proceedings, vol 80. Springer, Cham. https://doi.org/10.1007/978-3-030-64610-3_86
• 4. Naidech AM. Intracranial hemorrhage. Am J Respir Crit Care Med. 2011 Nov 1;184(9):998-1006. doi: 10.1164/rccm.201103-0475CI. PMID: 22167847; PMCID: PMC3361326.
• 5. Sun T, Yuan Y, Wu K, Zhou Y, You C, Guan J. Trends and patterns in the global burden of intracerebral hemorrhage: a comprehensive analysis from 1990 to 2019. Front Neurol. 2023 Nov 21;14:1241158. doi: 10.3389/fneur.2023.1241158. PMID: 38073625; PMCID: PMC10699537.
• 6. van Asch C. J., Luitse M. J., Rinkel G. J., van der Tweel I., Algra A., Klijn C. J. (2010a). Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 9 167–176. 10.1016/S1474-4422(09)70340-0
• 7. Hsieh JT, Ang BT, Ng YP, Allen JC, King NK. Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population. PLoS One. 2016 Apr 6;11(4):e0152945. doi: 10.1371/journal.pone.0152945. PMID: 27050549; PMCID: PMC4822850.
• 8. Ariesen M. J., Claus S. P., Rinkel G. J., Algra A. (2003). Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34 2060–2065. 10.1161/01.STR.0000080678.09344.8D
• 9. Ruíz-Sandoval JL, Cantú C, Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke. 1999 Mar;30(3):537-41. doi: 10.1161/01.str.30.3.537. PMID: 10066848.
• 10. Gül, Levent Hakan. A hospital-based study on long-term mortality and predictive factors after spontaneous intracerebral hemorrhage from Turkey. Neurology Asia 2009; 14 : 11 – 14
• 11. Cepeda S, Gomez PA, Castano-Leon AM, Martinez-Perez R, Munarriz PM, Lagares A. Traumatic intracerebral hemorrhage: risk factors associated with progression. J Neurotrauma. 2015;32:1246–53.
• 12. Bullock MR, Chesnut R, Ghajar J, et al. Surgical treatment of traumatic parenchymal lesions. Neurosurgery 2006;58:S25-46; discussion Si-iv.
• 13. Jolink, W.M.; Klijn, C.J.; Brouwers, P.J.; Kappelle, L.J.; Vaartjes, I. Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology 2015, 85, 1318–1324.
• 14. Smith, S.; Horgan, F.; Sexton, E.; Cowman, S.; Hickey, A.; Kelly, P.; McGee, H.; Murphy, S.; O’Neill, D.; Royston, M.; et al. The future cost of stroke in Ireland: An analysis of the potential impact of demographic change and implementation of evidence-based therapies. Age Ageing 2013, 42, 299–306.
• 15. Xing, Y., An, Z., Zhang, X. et al. Sex Differences in the Clinical Features, Risk Factors, and Outcomes of Intracerebral Hemorrhage: a Large Hospital-based Stroke Registry in China. Sci Rep 7, 286 (2017). https://doi.org/10.1038/s41598-017-00383-6
• 16. Chen C, Xie Y, Pu M, Deng L, Li Z, Yang T, Yin H, Zhang Z, Lv X, Liu X, Cheng J, Li Q. Age-related differences in risk factors, clinical characteristics, and outcomes for intracerebral hemorrhage. Front Aging Neurosci. 2023 Nov 3;15:1264124. doi: 10.3389/fnagi.2023.1264124. PMID: 38020784; PMCID: PMC10655109.
• 17. Monique Bueno Alves, João José Freitas de Carvalho, Georgiana Álvares Andrade Viana, Cícera Borges Machado, Bento Fortunato Cardoso dos Santos, Miguel Cendoroglo Neto, Gisele Sampaio Silva; Gender Differences in Patients with Intracerebral Hemorrhage: A Hospital-Based Multicenter Prospective Study. Cerebrovasc Dis Extra 1 March 2012; 2 (1): 63–70. https://doi.org/10.1159/000343187
• 18. Faghih-Jouybari M, Raof MT, Abdollahzade S, Jamshidi S, Padegane T, Ehteshami S, Fateh S. Mortality and morbidity in patients with spontaneous intracerebral hemorrhage: A single-center experience. Curr J Neurol. 2021 Jan 4;20(1):32-36. doi: 10.18502/cjn.v20i1.6377. PMID: 38011469; PMCID: PMC8511605.
• 19. Morotti A., Goldstein J. N. (2016). Diagnosis and Management of Acute Intracerebral Hemorrhage. Emerg. Med. Clin. North Am. 34 883–899. 10.1016/j.emc.2016.06.010 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
• 20. Podolsky-Gondim GG, Cardoso R, Zucoloto Junior EL, Grisi L, Medeiros M, De Souza SN, Santos MV, Colli BO. Traumatic Brain Injury in the Elderly: Clinical Features, Prognostic Factors, and Outcomes of 133 Consecutive Surgical Patients. Cureus. 2021 Feb 27;13(2):e13587. doi: 10.7759/cureus.13587. PMID: 33815990; PMCID: PMC8009446.
• 21. Rau C-S, Wu S-C, Chen Y-C, Chien P-C, Hsieh H-Y, Kuo P-J, Hsieh C-H. Effect of Age on Glasgow Coma Scale in Patients with Moderate and Severe Traumatic Brain Injury: An Approach with Propensity Score-Matched Population. International Journal of Environmental Research and Public Health. 2017; 14(11):1378. https://doi.org/10.3390/ijerph14111378
• 22. Layrisse-Landaeta, Veronica & Dincheva, Gabriela & Khedr, Shahenda & Geng, Andrew & Schombs, Michele & Maisha, Kazi & Chao, Steven & Chen, Chun-Cheng. (2024). Impact of English proficiency on use of Glasgow Coma Scale in geriatric patients with traumatic brain injury. Trauma Surgery & Acute Care Open. 9. e001439. 10.1136/tsaco-2024-001439.
• 23. Cloud GC, Williamson JD, Thao LTP, et al. Low-Dose Aspirin and the Risk of Stroke and Intracerebral Bleeding in Healthy Older People: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023;6(7):e2325803. doi:10.1001/jamanetworkopen.2023.25803
• 24. Shiozawa M, Koga M, Inoue H, Yamashita T, Yasaka M, Suzuki S, Akao M, Atarashi H, Ikeda T, Okumura K, Koretsune Y, Shimizu W, Tsutsui H, Hirayama A, Nakahara J, Teramukai S, Kimura T, Morishima Y, Takita A, Yamaguchi T, Toyoda K. Risk of both intracranial hemorrhage and ischemic stroke in elderly individuals with nonvalvular atrial fibrillation taking direct oral anticoagulants compared with warfarin: Analysis of the ANAFIE registry. Int J Stroke. 2023 Oct;18(8):986-995. doi: 10.1177/17474930231175807. Epub 2023 May 23. PMID: 37154598; PMCID: PMC10507992.