Areas for Improvement in the Treatment of Fall-Related Intracranial Bleeding in Older Adults
Abstract
Complications arising from head injuries obtained during falls, particularly intracranial bleeds (ICBs), are a major cause of morbidity and mortality in older people. For older adults, the most common mechanism of injury leading to ICBs is falling, and up to 43% of those hospitalised for these fall-related bleeds experience long-term disability. This audit set out to determine the effect of adherence to local and national guidelines for older people with fall-related ICBs.
We analysed clinical data pertaining to 84 people over the age of 65 (82.8 +- 8.50, 59.5% female) receiving care in the Royal Berkshire Hospital for post-fall intracranial bleeding. The collected data included demographic information, medical and functional history, fall severity (graded by height), ICB type and laterality, management (including time to CT, anticoagulation reversal, observations, and surgical input), and functional status at discharge. The primary outcome was functional decline (care needs, mobility, and independence pre-admission compared to discharge). Secondary outcomes included rate of complications and length of stay.
13.1% of people within our dataset died during their admission. 21.4% experienced a GCS drop during their admission and 19.0% experienced delirium. Other common complications included pneumonia (9.5%), hyponatraemia (7.1%), AKI (6.0%), and seizures (4.8%). Upon comparison of treatment to local and national guidelines, we observed two main areas for improvement: not enough people are transferred to major trauma centres (23%), and not enough people receive a head CT within the recommended time frame (52%). Importantly, those that did not meet guidelines were more likely to have a reduction in independence from pre-admission levels (relative risk 1.44, 95% CI [0.99, 2.08]).
These observations highlight specific areas for improvement in treatment of older adults with fall-related ICBs. They also suggest that increased adherence to guidelines improves post-admission function of older adults after falls.
Comments
Hi all - I'm joining…
Hi all - I'm joining remotely so please feel free to ask any questions here and I'll try respond promptly!
Poster 4828
How did your team safely deprescribe FRID & monitor delirium in your patient cohort?
Scope considerations and future work
Thank you for the comment! That's a really important question, and being honest with you - neither FRID de-prescribing nor granular detail of delirium monitoring were captured in this audit cycle. We benchmarked specifically against NG232, which doesn't name either as a standard, so they fell outside our scope.
What makes your question particularly pointed is that our data showed patients whose care didn't meet guidelines had a delirium risk ratio of 1.91 - so delirium is clearly a significant outcome in this cohort, and not being able to speak to how it was monitored or managed is a real limitation we'd acknowledge openly.
Both feel like natural additions to the next cycle - a validated delirium screen like 4AT at admission and discharge, and a medicines review field capturing FRID rationalisation, would add meaningful depth. If your team has a model for embedding that into a trauma audit we'd be very interested to hear about it.
Which parameter would you recommend from the standard delirium monitoring which you currently collect that you'd like to see in the next cycle?