A new report offers a protocol to help doctors tell if an older adult needs head imaging following a fall.
The goal of the project was to come up with a clinical rule that safely excludes older adults with clinically important intracranial bleeding who come to the emergency department after a fall, but don’t need for a computed tomography (CT) scan of the head. The report was published in CMAJ (Canadian Medical Association Journal) on Monday. Undergoing a CT on the head is often used to evaluate a person after a fall, but it’s not always needed and can be costly.
“Overuse of CT in this population prolongs the emergency department visit, which has been shown to increase the rate of delirium while also diverting resources from other emergency patients,” Kerstin de Wit, a researcher from Queen’s University in Kingston, Ontario. “Furthermore, not all emergency departments have 24-hour on-site CT scanning facilities, meaning that some of these patients may be transferred to another center.”
A team of emergency department doctors from the United States and Canada came up with the Falls Decision Rule, which can be used to identify people for whom it is safe to skip a head CT to rule out intracranial bleeding after a fall.
The researchers studied 4,308 people aged 65 years or older from 11 emergency departments in Canada and the US. All of the people went to an emergency department within 48 hours of falling. The median age of the participants was 83 years old, and 64% were female. Of the people studied, 26% took anticoagulant medication and 36% took antiplatelet medication — two drugs that can raise the risk of bleeding.
“We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5,” the authors wrote.
If doctors stick to the rule, it would avoid head CTs in 20% of the population, the authors said.
When the history of head injury or amnesia is unclear, the person who fell should receive neuroimaging, the authors noted.
