Elderly Fallers Get Head Injuries Early identification of Head Injuries in the Elderly Richard Hall Emergency Medicine Consultant

Introduction Head Injuries Elderly Commonest cause of Severe Injury (AIS>2) in patients either as isolated injury head injury or in association with other injuries Elderly Account for Risk 4 times as likely to die from severe trauma (ISS>15) if over age 65 10 times likely to die from trauma if ISS 8 -15 if age over 65

First Audit 2014 Royal Stoke University Hospital Audit Missed BPT – Commonest missed BPT Traumatic Intracranial Haemorrhage Retrospective analysis Case note review of missed BPT for identification of factors and applied NICE Guidelines Application of NICE guidance – 65.2% of cases would have been identified NICE plus warfarin – 73.9% RSUH criteria – 97.8% Intoxicated / confusion GCS <15 Persistent headache Vomiting Anticoagulated Loss of consciousness / amnesia

Early identification of patients Elderly Fallers Get Head Injuries (EFGHI) EFGH E – Elderly – age >65 F – Features – Vomiting Evidence of Head / Facial Injury On anticoagulants Features of stroke (FAST) G – GCS – 14 / increased confusion or <14 Height – found at bottom of stairs / Over 2metres

EFGHI Audit Pre-EFGHI Number of patients included in study (N) = 29 February 2015 Number of patients included in study (N) = 29 Mean age = 82.66 years Mean time to CT head = 3 hours 17 minutes Number of pathological CT scans = 10 (34.5%) Number of patients that died as a result of their head injury = 1 (3.45%) Number of patients that died as a result of other injuries = 1 (3.45%)

EFGHI Audit August 2015 N = 43 Mean age = 84 years Mean time to CT head = 1 hour 54 minutes Number of pathological CT scans = 7 (16.3%) Number of patients that died as a result of their head injury = 3 (6.99%) Number of patients that died as a result of other injuries = 0

EFGHI Audit Number of patients that had the EFGH tool applied = 17 (39.53%) Number of patients that the EFGH tool prompted a senior clinician to request an urgent CT head = 14 (32.56%) Mean time to CT head if EFGH tool prompted = 1 hour 10 minutes Mean time to CT head if EFGH tool was not applied = 2 hours 15 minutes

Sessional variation in head injuries More identified cases in August compared February More identified Decrease in overtime to CT ?Hawthorne effect Less ED overcrowding resulting in quicker time to be triaged / seen Not 100% compliance with use of form by triage staff

Thanks James Overton – FY2 emergency medicine for Audit into missed BPT Ben Arnold – FY2 emergency medicine for audit into EFGHI data

Future audits Where do elderly patients get injuries Demographics and anatomical injury pattern Code Red scan in the elderly Mechanism or cause and a/effect