Elderly Patients with low Energy Blunt Trauma: Head CT?

Here's a case I have presented to me frequently. The resident presents the case of a 78 yo who had a mechanical fall at home. The patient may or may not remember a head strike. I am asked the question, "They seem well, no headache and no loss of consciousness and not on anticoagulants, do I need to do a CT head?"

How would you answer? What do all the head injury scores say?

We know that older age is an independent predictor of intracranial injury. In these elderly patients our clinical judgement has been found to be unreliable in identifying those patients with serious intracranial injury. It is for that reason that elderly patients are excluded from low risk head injury scores. Both the NEXUS Head CT Instrument and the Canadian Head CT Injury Rule, only require a patient to be > 65 years old, to be called a high risk case requiring a CT scan. 

In this review we look at a secondary analysis of data from the National Emergency X-Radiography Utilization Study (NEXUS) Head Computed Tomography (CT) validation study.

LOGIN