Falling through the guidelines: Brain computed tomography findings in the elderly, A DGH experience
Abstract
Introduction
Falls remain one of the leading causes of emergency department attendance among older adults in England. In 2023/2024 alone, approximately 220,000 emergency admissions were attributed to falls, with mortality from accidental falls continuing to rise despite an overall reduction in incidence.
Frail patients frequently present with multimorbidity, polypharmacy, and delirium or dementia, often resulting in a reduced Glasgow Coma Scale (GCS) score unrelated to acute trauma. Current NICE guidelines for head injury assessment may inadvertently lead to over-imaging in this cohort. This audit aims to identify alternative predictors of abnormal brain imaging.
Method
We retrospectively analysed data of everyone seen by the Front Door Frailty team at St Helier Hospital over a period of 1 month – May 2025. Acquiring data from the electronic patient records system to assess reason for attendance, circumstances of the fall if they had one, any symptoms associated with the fall and relevant imaging. Data collection and analysis was completed using Microsoft Excel and SPSS Statistics.
Results
Over the period of May, the Frailty team saw 163 patients – of which 105 presented with a fall. Of the cases that fell 83 (79.0%) were unwitnessed, and prevalence of head injury was 26 (24.7%), on blood thinners was 31 (29.5%), focal neurology was 13 (12.3%), headache was 5 (4.8%), and confusion was 36 (34.2%). We conducted computed tomography (CT) imaging of the brain for 77 (73.3%) patients, of which found 7 (6.7%) cases with an acute finding. Of those with acute findings on brain imaging, 5 were confused, 4 had documented head injury and 2 were on blood thinners.
Conclusion
The proportion of patients presenting with fall and confusion with abnormal CT brain imaging was 13.9% which compares to a recent systematic review with a 15.6%, suggesting confusion as an independent predictor of acute abnormality.