What is the recommended treatment for a discharge injury from a fall?

From the Guidelines

Patients with a discharge injury from a fall who are on anticoagulant or antiplatelet therapy can be safely discharged after a normal initial head CT scan, as the risk of delayed intracranial hemorrhage (ICH) is low and rarely necessitates neurosurgical intervention. The most recent and highest quality study, 1, which is a clinical policy endorsed by the Emergency Nurses Association, suggests that the risk of delayed ICH after blunt head trauma in neurologically intact patients on anticoagulant or antiplatelet therapy is rare, and even if it does occur, it tends not to be clinically significant.

Some key points to consider in the management of these patients include:

• Providing clear discharge instructions with return precautions, as up to approximately 5% of these patients may develop delayed ICH 1
• Considering outpatient referral for assessment of both fall risk and risk/benefit of anticoagulation therapy, as recommended by 1
• The use of a single CT scan may be adequate to exclude an ICH after blunt head trauma, as suggested by 1
• The potential for delayed ICH is higher in patients on anticoagulants, particularly warfarin, compared to those on antiplatelet agents, as noted in 1

It is essential to weigh the benefits and risks of anticoagulant and antiplatelet therapy in these patients and to consider the potential consequences of withholding these medications. However, the current evidence suggests that the risk of delayed ICH is low, and most patients can be safely discharged after a normal initial head CT scan.

In terms of specific management, the following steps can be taken:

• For minor injuries, rest, ice, compression, and elevation (RICE) can be advised for the first 48-72 hours
• Over-the-counter pain medications like acetaminophen or ibuprofen can help manage pain and reduce inflammation
• For wounds, cleaning with mild soap and water, applying an antibiotic ointment, and covering with a sterile bandage can help prevent infection
• More severe injuries, such as fractures, deep lacerations, head injuries with loss of consciousness, or persistent severe pain, require immediate medical attention.

From the Research

Discharge Injury from Fall

The recommended treatment for a discharge injury from a fall is not explicitly stated in the provided studies. However, some studies provide information on the treatment and prevention of falls in older adults.

• The study 2 found that the use of warfarin, but not low-dose aspirin, might be associated with unfavorable outcomes in elderly patients with fall-induced traumatic intracranial hemorrhage.
• The study 3 concluded that low-dose aspirin does not increase surgically relevant parenchymal or meningeal bleeding following moderate and minor head injury in patients older than 60 years of age.
• The study 4 found that older people have low levels of knowledge about appropriate falls prevention strategies that could be used after discharge, and that healthcare workers should design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.
• The study 5 found that hospitalized older adults have limited perceptions about their fall risks while hospitalized and fall prevention interventions received while hospitalized, and that healthcare providers need to more fully engage patients and families in understanding fall prevention interventions and factors contributing to falls during hospitalization and at discharge.

Treatment of Fall-Related Injuries

Some studies provide information on the treatment of fall-related injuries, such as:

• The study 6 compared the treatment of pain in children with arm fractures by ibuprofen versus acetaminophen with codeine, and found that ibuprofen was at least as effective as acetaminophen with codeine for outpatient analgesia for children with arm fractures.

Prevention of Falls

The prevention of falls is an important aspect of treating discharge injuries from falls. Some studies provide information on falls prevention strategies, such as:

• The study 4 found that exercise has been identified as an effective falls risk reduction strategy, but only a small percentage of participants suggested engaging in exercises.
• The study 5 found that patients have limited perceptions about their fall risks while hospitalized and fall prevention interventions received while hospitalized, and that healthcare providers need to more fully engage patients and families in understanding fall prevention interventions and factors contributing to falls during hospitalization and at discharge.