Background

Falls are a common emergency department presentation in the elderly. A very small proportion of these patients develop intracranial bleeding as a result of the fall. At present, there are no guidelines on which patients should have a CT head scan in the emergency department, to exclude an intracranial bleed.

Aim

To derive a clinical decision rule which will identify which patients >65 years presenting to the emergency department after a fall, and do not require a CT head scan.

The following is a brief summary of the work to date.

Methods

This is a program of research consisting of

1). A two-hospital, prospective cohort study in Hamilton, ON (N=1700).

We have completed data on the first 890 patients, with 34 (3.8%) diagnosed with intracranial bleeding within 6 weeks of index visit.

Pilot data (Hamilton Health Sciences – General and Juravinski Hospitals Dec 2014 – Sep 2017)

2). A feasibility study at Mount Sinai Hospital, Toronto (N=50), follow up in progress.

3). An online survey of current emergency physician practice and desired characteristics of a new rule, in progress.

4). A systematic review, in progress.

5). A qualitative study interviewing these patients in the emergency department to identify patient and family priorities, in progress.

I am submitting a CIHR project grant application in March 2018, to fund a multisite study in Hamilton, Toronto, Ottawa and Quebec.