Falls in elderly are common and associated to heavy morbidities requiring hospitalizations. Bone and neurosurgical injuries are evaluated in emergency care but many cutaneous hematomas are misdiagnosed or neglected. We aimed to show the epidemiological importance of these skin hemorrhages and help for their management.

A retrospective review from specialized consultations reports was performed in the department of geriatrics of the university hospital of Geneva. Measurements were incidence of severe skin hematomas, their epidemiological and clinical characteristics. Details on consecutive care lead to the proposition of a guided structured management.

A total of 112 (53‰ – 95% CI=44.64) hematomas were seen between 2007 and 2010 during 2092 dermatological and surgical consultations at the department of geriatrics of the university hospital of Geneva. Mean age of the patients was 87.4±7.5 years and a majority of them were women (83.9%). Out of the 112 patients with hematomas 12.5% had diabetes, 39.3% were under antiaggregant therapy and 61.6% under anticoagulant therapy. There was a significant difference concerning sex, age, and anticoagulant therapy between patients presenting with severe hematomas and the geriatric population without hematomas during the observational period (P<0.001). Among all hematomas, 26 were deep dissecting hematomas. Medicosurgical care included 43 evacuation and drainage, three skin grafts, one vacuum-assisted-closure (VAC) therapy and five transfusions.

Hematomas often lead to serious morbidity and severe consequences such as anemia or extended wounds. Surgical interventions are required and consequently increase the length of hospital stay and costs. Prevention and management should be clarified.