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Original Article

The Role Of Head CT Scans In The Evaluation of Acute Intracranial Injuries

Kirill Alekseyev, Zachary Fallon, Malcolm Lakdawala, Adrian Cristian, Marc Ross.

Objective: To assess the incidence of clinically significant intracranial injuries identified by head CT for patients who fell during their stay at an inner city hospital.
Design: Retrospective chart review.
Setting: Acute inpatient rehabilitation unit of an inner city hospital.
Participants: A total of 346 patient falls, documented during their hospital course.
Interventions: Retrospective chart review of head CT-scans that were obtained for patients who fell during their stay on an inpatient rehabilitation unit over a 3 year period. Charts were reviewed for the following: results from the physical examination following discovery of the incident, evidence of intracranial injury as a consequence of the fall, and any prolonged hospitalization as a result of the fall associated intracranial pathology.
Main Outcome measures: Results of head CT-scans.
Results: 110 head CT scans (31.79%) were obtained as part of workup in a total of 346 patient falls that had a documented fall during their hospital stay. Each patient analyzed had between one and three head CT scans performed as a result of a fall. Only 1 of 110 head CT scans performed (0.91%) had a positive acute finding for a head injury. This patient required two follow up head CT scans.
Conclusions: There is a low diagnostic yield and high cost for head CT scans as part of post-fall evaluation in patients not exhibiting acute neurological changes. Physiatrists should use caution when ordering these imaging studies and limit their use to occasions when clinically indicated according to institution based guidelines based on a clinical decision aid.

Key words: Inpatient falls; Head CT; Fall related imaging; Acute hemorrhage; Cost reduction; Patient safety

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