Brain injury imaging overused in older adults after falls, study finds
Most people aged 65 and over with lower-risk head injuries do not have positive results on CT imaging, new research has found.
CT, or computed tomography, is a detailed X-ray that creates cross-sectional images.
The team, led by Yahy Al Fathil, a resident physician in the emergency department at Northern Hospital Epping in Melbourne, Australia, suggested their findings could inform frameworks to better stratify patient risk and guide more targeted use of cranial imaging.
The researchers said: “With all older adults deemed to require imaging in [mild traumatic brain injury] regardless of symptoms or mechanism, the additional cost of prolonged ED stays necessitates consideration, with the added burden to already crowded EDs.
“It is well established that extended ED stays are associated with delirium in older patients. As such, identifying factors that minimise unnecessary imaging in this patient cohort aligns with both optimising care for older adults and addressing healthcare system demands.”
To gauge the yield of head CT scans in emergency settings for adults 65 and over with lower-risk injuries, the team retrospectively analysed all CT brain studies performed for suspected head injury at their institution between June and August 2024. Clinical variables were compared alongside CT findings to determine whether certain factors were more likely to result in positive exams.
A total of 110 patients, with a median age of 73.5 years, met the team’s inclusion criteria. Of those, 8.2 per cent had positive CT scans.
When comparing clinical variables, those on anticoagulant medications, which thin the blood to prevent clotting, were significantly more likely to have positive findings.
New focal neurological deficits, meaning specific problems with brain function such as weakness on one side of the body, were also associated with acute intracranial pathology, meaning abnormalities inside the skull. Suspected skull fracture, loss of consciousness, vomiting and confusion were not.
The authors said: “While these findings are hypothesis-generating, they highlight potential opportunities to optimise CT use in older adults presenting after a fall.
“Documentation of anticoagulation status, baseline cognitive function, and frailty could be systematically incorporated into ED assessment to better identify higher-risk patients.”
The team added that although their findings warrant consideration of additional risk stratification systems in emergency department settings, more prospective data are needed before organisations change CT imaging criteria.
