British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 6, Issue.: 3
Use of Cranial Computed Tomography (CT) in Elderly Patients Presenting After a Fall: Can We Predict Those Having Abnormal Head CT Scans
Jennifer M. Bennett1, Nathan R. Nehus1, Matthew R. Astin2, Charles K. Brown1*, Reuben Johnson1 and Kori L. Brewer1 1Department of Emergency Medicine, The Brody School of Medicine at East Carolina University and Vidant Medical Center, Greenville, North Carolina, United States.
2Emergency Medicine / Internal Medicine, Mercer University School of Medicine, Medical Center of Central Georgia, Macon Georgia, United States.
Jennifer M. Bennett1, Nathan R. Nehus1, Matthew R. Astin2, Charles K. Brown1*, Reuben Johnson1 and Kori L. Brewer1
1Department of Emergency Medicine, The Brody School of Medicine at East Carolina University and Vidant Medical Center, Greenville, North Carolina, United States.
(1) Anonymous, Sudan.
(2) Alexander E Berezin, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine.
(3) Anonymous, Turkey.
Complete Peer review History: http://www.sciencedomain.org/review-history/7279
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.
Computed tomography; decision rules; elderly; fall; head injury.
Full Article - PDF Page 342-350
DOI : 10.9734/BJMMR/2015/10435Review History Comments