Geriatric Emergency Medicine Fellowship Journal Club: To CT or Not

Head injury is an increasingly common presenting complaint for older adults in the Emergency Department (ED). From 2007 to 2013, the number of traumatic brain injury (TBI)-related ED visits in adults 65 years and older increased from approximately 220 000 to 485 000 cases in the United States.1 Most of these injuries were fall-related. Fall-associated intracranial hemorrhages (ICH) in older adults are also increasing.2 The mortality rate associated with traumatic ICH is 15% and ICH accounts for onehalf of all fall-associated deaths in older adults.3,4 Clinical evaluation of geriatric trauma patients is complicated by frailty, polymorbidity, polypharmacy, anatomic and physiologic changes, and medication effects.5 Practice variation exists among emergency clinicians around when to obtain neuroimaging in older adults with falls, in part due to multiple clinical decision rules and misconceptions exist around their use. This article is a summary of the Journal Club on this topic held by the Geriatric EM Fellowship Journal Club series held on November 4, 2021, presented by the three authors. We review three articles that address the risk factors for ICH in older adults and that use clinical decision rules for guiding imaging in this population.