Introduction Falls remain the leading reason for elderly people to attend emergency department (ED), which in 2023 led to 250,000 hospital admissions in the UK. A seemingly large number of geriatric patients undergo CT head as an initial workup in ED which might not be necessary, especially in minor head trauma. NICE (National Institute for Health and Care Excellence), recommended risk stratification to reduce unnecessary head scanning which may potentially reduce ED length of stay, hospitalisation and medical expense. Our study evaluated the current practice of adherence to NICE guidance on Head Injury: assessment and early management for performing CT head scans in elderly admitted to Basildon hospital. Methods Two cycles of retrospective data collection were undertaken across three elderly care wards. Elderly patients admitted with falls who had CT head scans were identified. Indication for scanning were evaluated to determine adherence with NICE guidelines for head injury. Between cycles, formal educational sessions were provided to Junior Doctors by departmental teaching and distributing leaflets/posters explaining NICE guidance for indication of CT head scans in head injury. Results Following the interventions implemented, patient compliance to the NICE guidance for undergoing CT head with a history of falls, rose from 77.33% to 93.99%. No significant difference in abnormal CT head findings were demonstrated between cycles. In addition, mortality observed between cycles was near equivalent, 12% and 11.67% respectively. The mean time for CT head scans performed also improved, from 13 hours to 4 hours. Conclusion We demonstrated education regarding the indication for CT head scans in elderly with falls improved the appropriateness of scans performed in accordance with NICE guidance. CT head scans performed which more robustly met NICE guidance demonstrated no difference in adverse findings or patient mortality and may have contributed to reduced mean scan time, thus improving resource allocation.

中文翻译：

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2229 对因跌倒入院的老年 患者和遵守 NICE 指南的 CT 头部扫描的回顾。


简介 跌倒仍然是老年人去急诊科 （ED） 就诊的主要原因，2023 年英国有 250,000 人入院。看似大量的老年患者将头部 CT 作为 ED 的初始检查，这可能没有必要，尤其是在轻微的头部外伤中。NICE（英国国家卫生与临床优化研究所）建议进行风险分层，以减少不必要的头部扫描，这可能会减少急诊科的住院时间、住院时间和医疗费用。我们的研究评估了当前遵守 NICE 头部损伤指南的做法：对 Basildon 医院收治的老年人进行头部 CT 扫描的评估和早期管理。方法 在 3 个老年护理病房进行 2 个周期的回顾性数据收集。确定了因跌倒入院并进行了头部 CT 扫描的老年患者。评估扫描指征以确定是否符合 NICE 颅脑外伤指南。在周期之间，通过部门教学和分发传单/海报向初级医生提供正式的教育课程，解释 NICE 关于头部受伤时头部 CT 扫描指示的指南。结果 实施干预措施后，患者对有跌倒病史的头部 CT 接受 CT 指导的依从性从 77.33% 上升到 93.99%。周期之间头颅 CT 异常结果无显著差异。此外，在周期之间观察到的死亡率几乎相当，分别为 12% 和 11.67%。进行头部 CT 扫描的平均时间也有所改善，从 13 小时缩短到 4 小时。 结论 我们证明了关于跌倒老年人头部 CT 扫描适应症的教育提高了根据 NICE 指南进行的扫描的适当性。更符合NICE指南的头部CT扫描表明，不良发现或患者死亡率没有差异，可能有助于缩短平均扫描时间，从而改善资源分配。