From the Research
Elderly patients with head injuries and negative CT scans in the emergency department should be considered for discharge home if they have minor injuries, normal mental status, no concerning neurological findings, and adequate home support, but a more cautious approach is warranted for those with concerning presentations, as evidenced by the most recent study 1. When deciding on the disposition of elderly patients with head injuries and negative CT scans, several factors must be considered to prioritize their morbidity, mortality, and quality of life.
- The patient's mental status and presence of neurological deficits are crucial in determining the risk of underlying injuries that may not be immediately apparent on CT scans.
- The use of anticoagulants and the presence of multiple injuries or inadequate home support are factors that increase the risk of complications and necessitate a more cautious approach.
- A 24-hour observation period with a responsible caregiver is recommended for patients being discharged home to monitor for any neurological changes.
- Clear discharge instructions, including warning signs that necessitate return to the ED, such as worsening headache, vomiting, increased confusion, weakness, or seizures, are essential.
- Follow-up within 1-2 weeks is recommended for all patients to assess recovery and address any persistent symptoms, as supported by the study 1, which highlights the importance of a decision-tree based on objective clinical severity criteria for the indication of head CT in elderly patients with minor head trauma. The study 1 provides the most recent and highest quality evidence, indicating that a systematic head CT for elderly patients presenting minor head trauma could be irrelevant, and a decision-tree based on clinical severity criteria could detect the majority of traumatic intracranial hemorrhages requiring surgical intervention.
- The presence of focal neurological deficit and history of traumatic intracranial hemorrhage on a previous CT scan are significant predictors of traumatic intracranial hemorrhage, as noted in the study 1.
- The study 2 also suggests that male sex, consciousness impairment, focal neurological deficit, past history of post-traumatic brain injury, and time-interval between head trauma and CT are statistically related to the presence of lesions and should be taken into account when deciding on patient disposition. Overall, the disposition of elderly patients with head injuries and negative CT scans should be guided by a cautious approach, taking into account the patient's overall clinical presentation and risk factors for complications, as supported by the most recent evidence 1.