Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen

Study Overview
=================
Brief Summary
-----------------
Falls are the leading cause of traumatic death in the elderly with head injury causing half of these deaths. Each year, one in three adults over the age of 65 (seniors) fall, and half of these seniors seek treatment at a hospital emergency department (ED). There is a major evidence gap in the study of brain injury diagnosis in seniors, which is problematic for emergency physicians since the number of fall-associated head injuries is rising. ED diagnostic tools for risk stratification of these patients do not exist. The investigators will derive a novel ED clinical decision rule for detecting traumatic intracranial bleeding which will standardize the approach to head CT scans. Once validated, the investigators will optimize patient care by ensuring that intracranial bleeding is identified early. By reducing the use of head CT, this decision rule will lead to health care savings and streamlined, patient-centered ED care.

Detailed Description
-----------------
This study is designed to develop a unique clinical decision rule for ED physicians evaluating senior patients who have fallen. Clinical decision rules are a common method for standardizing diagnostic decision-making and minimizing misdiagnosis in the ED. Each patient will be assessed at their index ED visit by an emergency physician who will record history and examination findings. The primary outcome will be clinically important intracranial bleeding diagnosed with 42 days. Patients who return to the ED within 42 days with new confusion, headache, loss of balance, repeat falls, change in behaviour, reduced Glasgow Coma Scale score or other neurological symptoms will also undergo head CT. All intracranial bleeding events will be adjudicated independently.

Official Title
-----------------
Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen (the Falls Multicentre Study)

Conditions
-----------------
Fall, Intracranial Bleed

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 65+ years old Fall within 48 hours of emergency department visit (regardless of presenting complaint) Exclusion Criteria: Repeat event/visit (already enrolled in the study) Transferred from another hospital Lives outside of hospital catchment area Major trauma (e.g. fall from steps, fall from height, motor vehicle accident, struck by a vehicle, recreational accident) Left emergency department prior to completion of assessment (left against medical advice)

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinically important intracranial bleeding | Number of patients with bleeding within the cranial vault (including subdural, intracerebral, intraventricular, subarachnoid, epidural blood and cerebral contusion) which requires medical or surgical treatment. | Within 42 days of the index emergency department presentation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neurosurgical intervention | Number of patients with intracranial bleeding who undergo neurosurgical intervention. | Within 90 days | 
| Intensive care admission | Number of patients with intracranial bleeding who are admitted to the intensive care unit. | Within 90 days | 
| Hospital length of stay | Duration of hospitalization among patients with intracranial bleeding. | Within 90 days | 
| In-hospital death | Number of patients with intracranial bleeding who die in hospital. | Within 90 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
elderly, clinical decision rule, emergency department, CT scan, bleeding