Citation

Green L, Selleck L, Gibbons M, Klim S, Ritchie P, Patel R, Pham C, Kelly AM. Intern. Med. J. 2020; ePub(ePub): ePub.

Affiliation

Director, Joseph Epstein Centre for Emergency Medicine Research @ Western Health, St Albans Vic 3021 and Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, St. Albans, Vic, Australia, 3021.

Copyright

(Copyright © 2020, John Wiley and Sons)

DOI

10.1111/imj.14808

PMID

32092229

Abstract

OBJECTIVE: In 2014, the South Australian coroner recommended that residents of 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.The aim of this study was to determine the rate of emergent intervention (neurosurgery, transfusion of blood products or reversal of anticoagulation) 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 truama who had their usual cognitive function on ED assessment.

RESULTS: 366 patients were studied; median age 86, 45% taking anticoagulant/antiplatelet medication. 80% underwent head CT. 6% had ICH (95% CI 4-8.9%). No patient underwent neurosurgery. One had emergent intervention, reversal of anticoagulation (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. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Head trauma; aged care; intracranial bleeding