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No head CT required in cases with no history of head injury on falling, no amnesia of fall, no new abnormality on neurologic exam

A Falls Decision Rule can determine which elderly patients presenting with a fall require computed tomography (CT) of the head, according to a study published online Dec. 4 in CMAJ, the journal of the Canadian Medical Association.

Kerstin de Wit, M.B.Ch.B., M.D., from Queen’s University in Kingston, Ontario, Canada, and colleagues conducted a prospective cohort study in 11 emergency departments and enrolled 4,308 patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. Data were obtained for 17 potential predictor variables. Diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit was examined as the primary outcome.

The researchers found that 3.2 percent of the participants received a diagnosis of clinically important intracranial bleeding. A decision rule was developed, indicating that no head CT was required in cases with no history of head injury on falling, no amnesia of the fall, no new abnormality on neurologic examination, and a Clinical Frailty Scale score <5. The sensitivity and specificity of the rule were 98.6 and 20.3 percent, respectively, and the negative predictive value was 99.8 percent.

“The rule can be applied to all older adults who have fallen, regardless of whether they sustained a head injury or can recount the events of the fall,” the authors write. “The rule has the potential to standardize patient testing.”

One author disclosed ties to Amgen Canada.

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