The role of routine cranial CT imaging in geriatric head trauma: a retrospective analysis from a level I trauma centre in Germany.

Introduction: Geriatric patients with head trauma have an increased risk of intracranial injuries. Due to impaired clinical evaluability and the widespread antithrombotic use, cranial computertomography (cCT) is frequently performed. Research question: This study aims to determine the prevalence and risk factors for intracranial haemorrhage and to calculate the number needed to screen (NNS) for its detection in a geriatric cohort. Methods: A retrospective analysis was conducted on patients aged ≥65 years presenting to a level I trauma centre in Germany between January 2020 and October 2024 after a head impact and undergoing cCT imaging. Results: Among 2474 patients, 62.9 % were aged ≥80 years and 56.1 % were female. Intracranial haemorrhage occurred in 9.3 %, with 1.5 % requiring surgery. Risk factors for intracranial haemorrhage included female gender (OR = 1.4; p = 0.014), impaired consciousness (OR = 3.5; p < 0.001), presentation via resuscitation room (OR = 6.5; p < 0.001) and cervical spine injury (OR = 2.2; p < 0.001). The NNS for detecting intracranial haemorrhage was 10.7 in patients aged ≥65 years and 11.4 in those aged ≥80 years. The NNS in patients without impaired consciousness was 19.2 for those aged ≥65 years and 20.5 for those aged ≥80 years. The NNS for surgical intervention was 65.1 in patients aged ≥65 years and 111.1 in those aged ≥80 years. Discussion and conclusion: Intracranial haemorrhage is a common consequence of head trauma in older patients. Despite its high frequency, routine cCT is crucial for timely identification of acute intracranial pathologies, with the low NNS highlighting its diagnostic value and justifying its widespread use to optimize patients' outcomes.