Discussion of: "Is routine head CT indicated in awake stable older patients after a ground level fall?"

BACKGROUND: Despite the development of several prediction rules to guide head CT imaging, determining whom to screen for head trauma in the geriatric population after a ground level fall remains controversial. The purpose of this study was to assess the impact of head CT on the management of older adult patients who present with a normal GCS after a ground level fall, and to identify factors that could predict the need for neurosurgical intervention.

METHODS: A retrospective study was conducted on hemodynamically stable patients >55 years of age with GCS of 15, who presented to a level 1 trauma center after a ground level fall. Radiological reads of head CT scans were reviewed for new findings and clinical documentation was analyzed for evidence of a change in management. Univariate analysis of key demographic and clinical factors was performed to probe for statistically significant differences between patients receiving medical management versus surgical management.

RESULTS: Of 437 patients receiving head CTs, 146 (33.4%) had a positive finding. 95 (21.7%) patients had a change in management; 76 (17.4%) were medication changes and 19 (4.3%) required neurosurgical intervention. Age 85 years and older, and having a neurologic deficit on initial physical examination were found to be significantly associated with the need for neurosurgery.

CONCLUSION: The results of this study confirm that head CT findings often alter clinical management of elderly patients presenting with a GCS of 15 after ground level falls, and should be a part of standard evaluation.