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. 2023 Feb;35(1):41-47.
doi: 10.1111/1742-6723.14051. Epub 2022 Jul 25.

Potentially avoidable emergency department transfers from residential aged care facilities for possible post-fall intracranial injury

Igor Tulchinsky  1 , Richard Buckley  1 , Robert Meek  1   2 , Joel Jun Yi Lim  2
Affiliations

Potentially avoidable emergency department transfers from residential aged care facilities for possible post-fall intracranial injury

Igor Tulchinsky et al. Emerg Med Australas. 2023 Feb.

Abstract

Objectives: To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post-fall. To describe rates of CT brain (CTB) performance, intracranial trauma-related findings, neurosurgical intervention, and patient outcome.

Methods: Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made.

Results: Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23-30] vs 20% [95% CI 15-25], P < 0.001) and anticoagulant use (59% [95% CI 55-63] vs 42% [95% CI 37-49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma-related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup.

Conclusion: Just over half of the RACF to ED transfers were classified as 'potentially avoidable'.

Keywords: computed tomography; emergency department; head injury; residential aged care.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Patient flow: potentially avoidable transfers and outcomes. CTB, computed tomography brain; RACF, residential aged care facility.
Figure 2
Figure 2
Patient flow if computed tomography brain performed or not.
See this image and copyright information in PMC

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