Fast track CT scan and geriatric trauma team as a first line treatment of elderly patients with low energy fall and head injury

Abstract text (incl. references and figure legends)

Introduction

Undertriage of the geriatric trauma patient is common. Studies from the trauma registry at Stavanger University hospital have shown that this group is often exposed to head trauma. As a result of these findings, we have introduced new guidelines.

Material & Methods

We searched the trauma registry for patients ≥60 years of age, with ISS >15 and no trauma team activation three consecutive years from 01.01.17–31.12.20. This group of patients were dominated by falls <1m of height, head injuries as location of major injury (LOMI) with frequent use of anticoagulants and platelet inhibitors.

To provide better care for this fragile group new guidelines were introduced 03.02.21. Patients meeting four criteria; head injury AND age ≥60 AND any use of anticoagulants/platelet inhibitors AND injury within 24 hours, get a fast track to CT cerebrum. If CT reveal findings of hemorrhage and/or fracture geriatric trauma team is activated.

Results

After introduction of the new guidelines 609 patients have been included from 03.02.21–03.02.22. Cerebral hemorrhage or skull fracture was seen in 34/609 and 25/34 had a geriatric trauma team activation. Subdural hematoma was encountered in 15/34 and, 13/34 had subarachnoid hemorrhage. Parenchymal or subcortical hemorrhage was encountered in 5/34 and 1/34 had skull fracture. Findings additional to head injury was seen in 5/34. Three patients underwent emergency surgery, 1 craniectomy and 2 radiologic coiling of other injuries.

Mean time to CT in the undertriaged group identified before introduction of protocol was 118 minutes. After introduction of the new protocol the mean time from admittance to CT examination is now 18 minutes.

Conclusions

Introduction of guidelines with fast track CT cerebrum and geriatric trauma team has improved time to diagnosis drastically. Elderly patients with confirmed head injury are now taken care of immediately, by a defined and well-trained geriatric trauma team.

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