Dr. Kerstin de Wit
Each year, one in three adults over the age of 65 has a fall. These falls lead to half a million Canadian emergency department patient visits annually and falls in older adults account for more than 3% of all emergency department visits. A rapid, simple bedside test (known as a decision rule) to guide emergency physicians on when older adults should have a brain scan to diagnose traumatic brain bleeding was created. This decision rule will be checked to see if it works well in guiding who needs a brain scan.
Traumatic intracranial bleeding is much more prevalent in older adults and has a much worse prognosis as compared to the younger population. Older adults are at risk of traumatic intracranial bleeding because there is loss of the elastic integrity of the cerebral bridging veins and brain atrophy, allowing rapid movements of the brain with trauma. The vast majority of traumatic intracranial bleeding diagnoses in older adults result from low-energy falls from standing or sitting. In 2015, the Canadian Medical Association called for a national strategy for older adults that would include evidenc…
Inclusion Criteria: * Age 65 or older * Present to the emergency department within 48 hours of having a fall * Fall from standing, from a chair, toilet seat, or bed Exclusion Criteria: * Transferred from another hospital organization after brain imaging * Leave the emergency department prior to completion of their medical assessment * Previously enrolled * Lives outside the hospital catchment area
The Falls Decision Rule will help guide emergency physicians when to obtain brain imaging and when brain imaging is not required.