Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;50(9):1048-1052.
doi: 10.1111/imj.14808.

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

Lorne Green  1 , Lucy Selleck  1 , Michael Gibbons  1 , Sharon Klim  2 , Peter Ritchie  1 , Rajesh Patel  2 , Chris Chi Hong Phuc Pham  1 , Anne-Maree Kelly  2   3
Affiliations

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

Lorne Green et al. Intern Med J. 2020 Sep.

Abstract

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 <1%. None underwent neurosurgical intervention. The low rate of intervention seriously challenges the appropriateness of routine transfer and CT for this patient group.

Keywords: aged care; head trauma; intracranial bleeding.

PubMed Disclaimer

Comment in

References

    1. SA Cor 5/2014 (0526/2011).
    1. Australian Government Department of Health. Industry alert: anticoagulant therapy and falls resulting in head injuries. 2016 [cited 2018 Oct]. Available from URL: https://us10.campaign-archive.com/?u=1108de8332cef333bc1956686&id=77...
    1. Ganetsky M, Lopez G, Coreanu T, Novack V, Horng S, Shapiro NI et al. Risk of intracranial hemorrhage in ground-level fall with antiplatelet or anticoagulant agents. Acad Emerg Med 2017; 24: 1258-66.
    1. Campiglio L, Bianchi F, Cattalini C, Belvedere D, Rosci CE, Casellato CL et al. Mild brain injury and anticoagulants. Less is enough. Neurol Clin Pract 2017; 7: 296-305.
    1. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A et al. The Canadian CT head rule for patients with minor head injury. Lancet 2001; 357: 1391-6.

LinkOut - more resources