Use of Cranial Computed Tomography (CT) in Elderly Patients Presenting After a Fall: Can We Predict Those Having Abnormal Head CT Scans

Aims: Identify factors predictive of increased risk of intracranial injury and assess the ability of the non-age related components of the New Orleans head CT criteria (NOC) to guide decision-making.
Study Design: Retrospective electronic medical record review and application of decision rule.
Place and Duration of Study: Emergency Department (ED) of Vidant Medical Center, Department of Emergency Medicine, Brody School of Medicine at East Carolina University; Greenville North Carolina, USA; January 2008 through December 2008
Methodology: Electronic Medical Records (EMR) of patients > 65 years of age coming to our Emergency Department during 2008 with a diagnosis of fall or traumatic injury were reviewed. Demographics, fall/injury details, risk factors, CT performance, and CT findings were recorded. Revisit within 30 days was reviewed. Non-age related NOC were applied to the population. Transfers, known intracranial injury, and multisystem trauma were excluded. Independent predictors of positive findings were sought using logistic regression.
Results: We identified 783 patients with fall and traumatic injury. Ninety-six met exclusion criteria, leaving 687 for analysis. Three hundred twenty one patients received head CT; 296 met the non-age NOC for head CT. Twelve (3.1%) abnormal head CTs were identified; nine showed an acute finding. Acute findings were not predicted by any independent variable. All 12 of the abnormal head CTs (nine acute, three chronic) were identified by the non-age NOC. Forty five patients presented again within 30 days with no injuries noted.
Conclusion: Age over 65 did not increase the risk for acutely abnormal head CT in the patient presenting to the ED after a fall. No single factor was predictive of acutely abnormal head CT. The use of the non-age related NOC predicted those patients having an abnormal head CT with 100% accuracy. Age may not independently necessitate head CT after a fall.