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

2. 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 if age over 65

3. 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

4. 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

5. EFGHI Audit Pre-EFGHI Number of patients included in study (N) = 29
February 2015
Number of patients included in study (N) = 29
Mean age = 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%)

6. 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

7. 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

8. 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

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

10. 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