E1499. CT or No CT: Imaging Geriatric Patients with Head Injuries in the Emergency Department, an Analysis of 14-Day Return Visits and Mortality
  1. Gregory Demirjian; Charles E. Schmidt College of Medicine at Florida Atlantic University
  2. Gabriella Engstrom; Charles E. Schmidt College of Medicine at Florida Atlantic University
  3. Scott Alter; Charles E. Schmidt College of Medicine at Florida Atlantic University
A head injury is a prominent ailment among the general population. In 2010, the Centers for Disease Control and Prevention documented 1.7 million individuals sustaining traumatic brain injuries (TBI), with 275,000 hospital admissions and 52,000 deaths. The people most likely to experience a TBI are children, adolescents, and adults over age 65 years. Those older than 75 years have the highest rates of TBI-associated hospitalization and death, with injuries most often secondary to a fall. In the emergency department (ED), physicians decide on the need for head computed tomography (CT) imaging in patients with head injuries hoping to avoid poor outcomes, including return to the hospital or death. This study compares 14-day return ED visits and mortality in geriatric patients who did and did not receive a head CT following a head injury.

Materials and Methods:
A prospective study was conducted at two level-one, university-affiliated trauma centers, with annual ED volumes of 50,000 and 69,000 patients. These are the only trauma centers serving one county. The study received approval from the university’s institutional review board. All ED patients from August 2019 to August 2020 that had an International Classification of Diseases-10 code S00 to S09 or had a head CT were screened for enrollment. Participants included those age 65 years or greater with head trauma. Patients with penetrating trauma or an injury that occurred greater than 24 hours prior to presentation were excluded. Patients were grouped by performance of head CT. Of those with head CT, patients were further grouped into positive or negative for intracranial hemorrhage (ICH). All patients were followed for 14 days to assess for return ED visits and mortality. Reason for return was further determined to be related to the initial injury or not. Groups were compared by chi-squared analyses.

Of 5422 patients enrolled, 20 (1%) did not have a head CT. Of those with a head CT, 4994 (92%) were negative for ICH. Mortality was higher in the no CT group than the CT group (15.0% vs. 4.3%, p = 0.019). There was higher mortality in the no CT group than the negative ICH CT group (15.0% vs. 3.5%, p = 0.005), but no difference between the no CT and positive CT groups (15.0% vs. 14.5%, p = 0.947). In the CT group, 520 patients (10%) had 549 return ED visits within 14 days, 50% in relation to the initial injury. There were no return ED visits in the no CT group.

In geriatric patients with a head injury, those who did not have a head CT were more likely to die and less likely to return to the ED. Of patients who had a head CT, the most common reason for return to the ED was related to the initial injury. The decision to obtain a head CT following a head injury often dictates management, thus analyzing for differences in outcomes may serve as practice-changing knowledge.