As the aging population, emergency departments are increasingly handling a greater number of elderly individuals who falls. Falling on even ground, such as in one’s home, is frequently a leading factor in causing a brain hemorrhage. While computed tomography (CT) scans of the head are frequently utilized in evaluating patients who have fallen, the practice of sending every fallen patient for a head scan is both inefficient and costly.
Dr. Kerstin de Wit, along with colleagues from the Network of Canadian Emergency Researchers, has noted that excessive use of CT scans in this group of patients can lead to longer stays in the emergency department. This has been linked to a higher incidence of delirium and can also result in a strain on resources that could be used for other emergency patients. Additionally, some emergency departments do not have round-the-clock CT scanning facilities on site, which means that certain patients may need to be transferred to another center.
A group of doctors working in emergency departments across Canada and the United States collaborated to formulate the Falls Decision Rule. This tool enables the identification of patients for whom it may be safe to skip a head CT scan to check for intracranial bleeding after a fall. The study involved 4308 individuals aged 65 or older from 11 emergency departments in Canada and the US, who had sought emergency care within 48 hours of experiencing a fall. The median age of the participants was 83 years, 64% of whom were female. 26% were taking anticoagulant medication and 36% were taking antiplatelet medication, both of which are known to increase the risk of bleeding.
By applying the rule, it is possible to eliminate the need for head CT scans in 20% of the study population, making it applicable to all older adults who have experienced a fall, regardless of whether they suffered a head injury or can recall the fall incident. This new guideline is a valuable addition to the well-established Canadian CT Head rule, which is designed for patients experiencing disorientation, amnesia, or loss of consciousness.
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Post time: Mar-08-2024
