Low Yield, Long Stay: ED Burden of Head Injury Assessment in Anticoagulated Adults aged 65 and over​

Introduction:  

People aged over 65 who take anticoagulants commonly present to the Emergency Department (ED) for assessment following a head injury. It is well documented that prolonged ED stays are associated with increased complications and morbidity particularly in older people with frailty. This audit aims to quantify the experience of people undergoing assessment in ED following a head injury.   

Methods:

This retrospective audit reviewed people presenting to EDs over a 3-month period. People included were aged 65+, taking anticoagulants, who underwent a CT scan for head injury. Data collected included time of presentation, time to be seen by a Clinician, time from presentation to CT, time to CT results and ED length of stay.  

Results:

Over a 3-month period, 179 people met the inclusion criteria. Overall, 172 (96.1%) people had no acute intracranial injury. Of these, 82 (45.8%) had no other significant issues and were discharged directly home. For those discharged home: the median time to be seen by a clinician was 82 minutes, median time to CT was 166.5 minutes, median length of stay in ED was 375 minutes with a range between 153 and 1521 minutes. ED attendances between 0000 and 0600 had an average 2 hour increased length of stay compared to attendances between 0600 and 1200.

Conclusion: 

Routine assessment for a head injury in anticoagulated people aged over 65 via ED has a significant impact on people who typically spend over 6 hours in ED despite not sustaining significant injuries. This contributes to increased burden on EDs which are already under strain. Based on these findings, we recommend exploring the feasibility of alternative care pathways for assessing people with uncomplicated isolated head injuries such as via a same day emergency care clinic. This would reduce length of stay, improve patient experience and reduce ED crowding.