Falls Decision Rule Easily Determines Whether Elderly Patients Would Benefit From Neuroimaging

Background: Ground-level falls are very common among the elderly, and these falls are the most common cause of traumatic intracranial hemorrhage. However, the rate of intracranial bleeding from these falls is about 5%, meaning that there are a lot negative head CTs being ordered. This overuse diverts resources away from other emergency department (ED) patients and can lead to patients being transferred if CT is not available. Objective: To devise a clinical decision rule that can be applied to all older adults with the presenting history of fall. Design: Prospective cohort study. Participants: Patients aged ≥65 years at 11 academic hospitals in Canada and the United States who presented to the ED within 48 hours of a ground-level fall. Methods: The decision to order a head CT was made by the ED physician. The patient was then followed up for 42 days. This time was chosen to include all delayed intracranial bleeds. The primary outcome of the study was defined as intracranial hemorr more...