Most urgent head CTs for older adults provide little value
Older adults who have sustained falls often undergo imaging when seeking medical attention for their injuries. New data, however, indicate that exams in this population are likely overutilized.
Published in the Cureus Journal of Medical Science, the findings suggest that the majority of older adults (65+) with lower risk head injuries do not have positive findings on CT imaging. Researchers further quantified the data to determine whether specific clinical and patient factors were linked to the likelihood of having a positive exam, uncovering multiple associations while also ruling others out.
The team suggested their findings could be used to create frameworks that better stratify patient risk in order to guide more targeted use of cranial imaging.
“With all older adults deemed to require imaging in [mild traumatic brain injury] regardless of symptoms or mechanism, the additional cost of prolonged ED stays necessitates consideration, with the added burden to already crowded EDs,” Yahy Al Fathil, a resident physician in the emergency department at Northern Hospital Epping in Melbourne, Australia, and colleagues cautioned. “It is well established that extended ED stays are associated with delirium in older patients. As such, identifying factors that minimize unnecessary imaging in this patient cohort aligns with both optimizing care for older adults and addressing healthcare system demands.”
To get a better idea of the yield of head CTs done in emergency settings on adults 65 and older with lower-risk injuries, the team retrospectively analyzed all CT brain studies performed for suspected head injury at their institution between June and August 2024. Clinical variables were compared alongside CT findings to determine whether certain factors were more likely to result in positive exams.
A total of 110 patients with a median age of 73.5 years old met the team’s inclusion criteria. Of those, just 8.2% had positive CT scans. When comparing clinical variables, those who were on anticoagulant medications were significantly more likely to have positive findings; new focal neurological deficits also were associated with acute intracranial pathology, while suspected skull fracture, loss of consciousness, vomiting and confusion were not.
“While these findings are hypothesis-generating, they highlight potential opportunities to optimize CT use in older adults presenting after a fall,” the authors noted. “Documentation of anticoagulation status, baseline cognitive function, and frailty could be systematically incorporated into ED assessment to better identify higher-risk patients.”
The team added that although their findings warrant consideration of additional risk stratifications systems in ED settings, more prospective data are needed before organizations change CT imaging criteria.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.