Does the evidence justify routine transfer of residents of aged care facilities for CT scan after minor head trauma?

Background In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for t...

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Bibliographic Details
Published in:Internal medicine journal 2020-09, Vol.50 (9), p.1048-1052
Main Authors: Green, Lorne, Selleck, Lucy, Gibbons, Michael, Klim, Sharon, Ritchie, Peter, Patel, Rajesh, Pham, Chris (Chi Hong Phuc), Kelly, Anne‐Maree
Format: Article
Language:English
Subjects:
Aged
aged care
Aged, 80 and over
Australia
Blood transfusion
Coagulation
Cognitive ability
Computed tomography
Consciousness
Craniocerebral Trauma - diagnostic imaging
Craniocerebral Trauma - therapy
Elder care
Emergency medical care
Glasgow Coma Scale
Head
Head injuries
head trauma
Hemorrhage
Humans
intracranial bleeding
Medical imaging
Medical records
Neurosurgery
Patients
Retrospective Studies
Tomography, X-Ray Computed
Trauma
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Summary:Background In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for the recommendation is unclear. Aims To determine the rate of emergent intervention (neurosurgery, transfusion of blood products or reversal of anti‐coagulation) in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Methods This was a retrospective cohort study by medical records review at two university‐affiliated community ED. Participants were patients from RACF attending ED who had suffered minor head trauma and had their usual cognitive function. Exclusions were altered conscious state, new neurological findings or associated orthopaedic injury requiring hospital admission. The primary outcome was rate of emergent intervention in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Results A total of 366 patients was studied; median age 86 years, 45% taking anti‐coagulant/anti‐platelet medication. Eighty per cent underwent head CT. Six per cent had intracranial haemorrhage (ICH; 95% CI 4–8.9%). No patient underwent neurosurgery. One had emergent intervention, reversal of anti‐coagulation (0.3%, 95% CI 0.05–1.5%). Conclusion The rate of emergent intervention for ICH in patients from RACF who sustained a minor head trauma but had their normal cognitive function was
ISSN:1444-0903
1445-5994
DOI:10.1111/imj.14808