Grant: Project Grant

There is very little research on diagnosing serious head injury (brain bleeds) in the elderly. One in three seniors experiences a fall each year and half of these people are treated in the emergency department. Almost all serious head injuries in older adults are caused by falling, and one case in six is fatal. Although falls are common for seniors, only 5% of those who are seen in the emergency department have a brain bleed. Over half of the seniors who go to the emergency department after a fall have a head CT scan. Currently, very few head scans done in the emergency department are positive for a brain bleed and the diagnosis is initially missed in 1 in 5 patients with a brain bleed. Ordering a head scan can prolong the emergency department stay by several hours. The emergency department can be an unpleasant and uncomfortable environment. We will create a new test (a clinical decision rule) which tells emergency doctors whether a head scan is needed or not. We will ensure that this new rule is safe. The rule will identify everyone who has a brain bleed, but will also lead to fewer head scans overall. This will allow patients with brain bleeds to receive the care they need and avoid unnecessarily long waits in the emergency department for those who do not have a brain bleed. Our study will follow 4000 people over the age of 65, who are treated in emergency departments across Canada after a fall. The emergency doctor will collect information about the risks of having a brain bleed and will follow a protocol for ordering a head scan. We will follow each patient for 6 weeks, to determine whether they are diagnosed with bleeding in the brain or not. We will use this information to develop a simple and safe test designed to guide emergency head scanning and improve the quality of care offered to seniors.