RT Journal Article
SR Electronic
T1 Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1614
OP E1621
DO 10.1503/cmaj.230634
VO 195
IS 47
A1 de Wit, Kerstin
A1 Mercuri, Mathew
A1 Clayton, Natasha
A1 Mercier, Éric
A1 Morris, Judy
A1 Jeanmonod, Rebecca
A1 Eagles, Debra
A1 Varner, Catherine
A1 Barbic, David
A1 Buchanan, Ian M.
A1 Ali, Mariyam
A1 Kagoma, Yoan K.
A1 Shoamanesh, Ashkan
A1 Engels, Paul
A1 Sharma, Sunjay
A1 Worster, Andrew
A1 McLeod, Shelley
A1 Émond, Marcel
A1 Stiell, Ian
A1 Papaioannou, Alexandra
A1 Parpia, Sameer
A1 
YR 2023
UL http://www.cmaj.ca/content/195/47/E1614.abstract
AB Background: Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head.Methods: This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression.Results: The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%–99.6%), specificity was 20.3% (95% CI 19.1%–21.5%) and negative predictive value was 99.8% (95% CI 99.2%–99.9%).Interpretation: We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755.