Introduction:
CT (Computed Tomography) head scans are often performed as part of the falls pathway in hospitals. We reviewed the use of CT scans in inpatient falls based on current guidelines and examined the presence of other clinical variables in patients with intracranial haemorrhages (ICH), with a view to improving the utility of CT scans, reducing unnecessary investigations and easing the burden on the health system.
Methods:
Patients who had a fall at the Princess Alexandra Hospital in 2019 in whom a CT scan was performed within 24 hours were identified by cross referencing the incident report and radiology databases. An audit of a subset of 100 incidents was carried out. We collected demographics, type of fall, antiplatelet/anticoagulants, indications for and results of CT, neurological observations and overall outcome from the Integrated Electronic Medical Records.
Results:
There were 364 falls in 2019 where a CT scan was done. Of the 100 incidents audited, 78% were unwitnessed. The mean age was 68 and cognitive impairment was present in 46%. The main reasons for ordering CT scans were head-strike and being on antiplatelet/anticoagulants. ICH was present in 10% with neurosurgical intervention in one case. Head-strike, altered GCS, new neurology and antiplatelet/anticoagulants were the main factors associated with ICH.
Conclusion:
Factors accompanied with ICH were similar to previous studies. Patients with cognitive impairment present a difficult population to assess clinically. We recommend modification of the current falls pathway in Queensland to improve utilization of CT scanning.