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      Potentially avoidable emergency department transfers from residential aged care facilities for possible post‐fall intracranial injury

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          Abstract

          Objectives

          To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post‐fall. To describe rates of CT brain (CTB) performance, intracranial trauma‐related findings, neurosurgical intervention, and patient outcome.

          Methods

          Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made.

          Results

          Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23–30] vs 20% [95% CI 15–25], P < 0.001) and anticoagulant use (59% [95% CI 55–63] vs 42% [95% CI 37–49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma‐related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup.

          Conclusion

          Just over half of the RACF to ED transfers were classified as ‘potentially avoidable’.

          Abstract

          Residential aged care facility (RACF) residents are frequently transferred to EDs due to concern of possible intracranial injury post‐fall. We found that although CT brain (CTB) performance was common, over half of these transfers were potentially avoidable, since patients returned to their RACF without active management, regardless of CTB findings.

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          Most cited references21

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          Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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            Indications for computed tomography in patients with minor head injury.

            Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT. In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT. Using recursive partitioning, we derived a set of criteria to identify all patients who had abnormalities on CT scanning. In the second phase, the sensitivity and specificity of the criteria for predicting a positive scan were evaluated in a group of 909 patients. Of the 520 patients in the first phase, 36 (6.9 percent) had positive scans. All patients with positive CT scans had one or more of seven findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3 percent) had positive scans. In this group of patients, the sensitivity of the seven findings combined was 100 percent (95 percent confidence interval, 95 to 100 percent). All patients with positive CT scans had at least one of the findings. For the evaluation of patients with minor head injury, the use of CT can be safely limited to those who have certain clinical findings.
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              The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

              Background Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls. Methods Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records. Results Globally, the age-standardised incidence of falls was 2238 (1990–2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622–5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5–9.8) per 100 000 which equated to 695 771 (644 927–741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897–17 636 830) YLLs, 19 252 699 (13 725 429–26 140 433) YLDs and 35 940 787 (30 185 695–42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age. Conclusions This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.
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                Author and article information

                Contributors
                Role: Emergency Physician
                Role: Medical Officer
                Role: Emergency Physician, Associate Professorrobert.meek@monash.edu
                Role: Medical Student
                Journal
                Emerg Med Australas
                Emerg Med Australas
                10.1111/(ISSN)1742-6723
                EMM
                Emergency Medicine Australasia
                Wiley Publishing Asia Pty Ltd (Melbourne )
                1742-6731
                1742-6723
                25 July 2022
                February 2023
                : 35
                : 1 ( doiID: 10.1111/emm.v35.1 )
                : 41-47
                Affiliations
                [ 1 ] Department of Emergency Medicine Monash Health Melbourne Victoria Australia
                [ 2 ] School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
                Author notes
                [*] [* ] Correspondence: Associate Professor Robert Meek, Dandenong Hospital, 33‐35 David Street, Dandenong, VIC 3175, Australia. Email: robert.meek@ 123456monash.edu

                Author information
                https://orcid.org/0000-0002-3104-0780
                Article
                EMM14051
                10.1111/1742-6723.14051
                10087771
                35879249
                45b7cf44-6547-490c-9195-a49869926254
                © 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 27 June 2022
                : 06 June 2022
                : 03 July 2022
                Page count
                Figures: 3, Tables: 3, Pages: 7, Words: 4671
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                February 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.7 mode:remove_FC converted:11.04.2023

                computed tomography,emergency department,head injury,residential aged care

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