Emergency department staff now have a new tool to determine whether older adults who have fallen require imaging, thanks to a new decision rule described in a study published in the Canadian Medical Association Journal. With the increasing number of older adults falling, particularly on level ground such as their own homes, there is a growing need to assess potential brain injuries. However, the routine use of computed tomography (CT) scans for every patient who has fallen is inefficient, costly, and often unnecessary.
Excessive use of CT scans in this population not only prolongs emergency department visits but also contributes to the increased rate of delirium among patients. Additionally, not all emergency departments have access to 24-hour on-site CT scanning facilities, which may require patients to be transferred to another medical center for imaging.
To address these issues, a team of emergency department physicians from Canada and the United States developed the Falls Decision Rule. This rule allows emergency department physicians to identify patients who can safely forego a head CT scan to rule out intracranial bleeding after a fall.
The study included 4,308 patients aged 65 years or older from 11 emergency departments across Canada and the United States. The median age of the patients was 83 years, with 64% being female. Approximately 26% of the patients took anticoagulant medications, while 36% took antiplatelet medications, both of which increase the risk of bleeding.
The Falls Decision Rule, if implemented, would eliminate the need for head CT scans in 20% of the study population. This rule can be applied to all older adults who have fallen, regardless of whether they sustained a head injury or can recall the fall.
The Falls Decision Rule complements the widely used Canadian CT Head rule, which is applied to patients with symptoms such as disorientation, amnesia, or loss of consciousness. By providing a more targeted approach to determine the necessity of CT scans after falls in older patients, emergency departments can optimize resources and deliver more efficient care. This rule will help reduce unnecessary healthcare costs associated with overuse of scans, while also minimizing the risk of delirium in older adults.
Implementing the Falls Decision Rule in emergency departments can lead to better allocation of resources, with CT scans being reserved for patients who truly require them. This can potentially reduce patient wait times, improve overall healthcare efficiency, and enhance patient outcomes.
Further research and adoption of the Falls Decision Rule in emergency departments across the globe may lead to standardized practices in managing falls in older adults. By following this rule, physicians can provide accurate and appropriate assessments and reduce the unnecessary exposure of older adults to radiation from CT scans.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
