Minor Head Injury in the Older Adult: Do All Patients Greater Than 65 Years Old Require Head Computed Tomography?

Document Type

Conference Proceeding

Publication Date

9-2025

Publication Title

Annals of Emergency Medicine

Abstract

Study Objectives: A body of literature has evolved to guide decisionmaking for when to obtain head CT imaging of patients after minor head injury (MHI). The existing decision rules, including the Canadian Head CT Rule (CHCTR), incorporate age ≥65 years as a criterion for head CT consideration, even if age is the only identified risk factor. A more nuanced understanding of older patients, including presence of other clinical criteria for CT imaging and associated outcomes, could inform refinements to evidence-based clinical decisions. Our objectives are to describe the characteristics of older adults with MHI and to compare resource utilization, clinical outcomes, and revisits across different age groups. Methods: This is a multicenter retrospective study spanning hospital systems throughout Michigan (42 emergency departments) that contribute to the MEDIC data registry, which contains clinical (eg, ICD-10-CM diagnoses, demographics, etc) and abstracted data from electronic health records. Adult patients who presented to a study ED with a head injury chief complaint from April 2016-March 2024 were screened for MHI, as indicated by initial Glasgow Coma Scale of 15. MHI cohort exclusions were: presentation >24 hours after injury, pregnancy, history of shunt or mass, bleeding disorder or anticoagulation, penetrating trauma or suspected abuse, cognitive or neurologic deficits, as identified by trained abstractors. CHCTR criteria were also abstracted. Descriptive statistics were calculated. We compared head CT utilization, CT findings of potential or definite severe injury-based ICD-10-CM codes, and 7-day return visits across age cohorts: 18-64, 65-74, 75-84, and > 84 years using chi square statistics and Fisher’s exact test category. Results: A total of 98,038 patients with MHI were identified and 17,827 had cohort exclusions; 6,323 (35.5%) excluded were aged ≥65 years. Among the 80,211 patients included in analysis 19,032 (23.7%) were aged ≥65, 47.8% male, 66.6% white, 19.1% Black, 5.3% Hispanic, 43% presented outside of clinic hours, 34.1% presented via ambulance, and 58.7% had an estimated severity index 3. Head CTs were obtained for 56.6% of the sample overall, ranging from 47.8% for patients 18 to 64 years old to 91.0% for patients 85 years and older, p < 0.001 (Table). Among the 16,767 patients for whom age was the only CHCTR criterion, 84.1% received a head CT. The rate of definite or possible severe TBI decreased with increasing age cohort (Table). Return visits were similar across age groups but the youngest and oldest age groups had higher 7-day return visits than the middle two age groups. Conclusion: In this preliminary analysis, amongst patients with MHI, younger patients had higher rates of TBI than those ≥ 65 years old. Older patients had markedly higher rates of HCT utilization, and most older patients had only age as CHCT criteria for imaging. We observed no difference in rates of TBI in patients for which age was the only CHCT criteria for imaging. Definite or possible severe TBI rates were lower with increasing age overall, suggesting some imaging may be deferred in these patients.

Volume

86

Issue

3 Suppl 1

First Page

S102

Comments

ACEP (American College of Emergency Physicians) Research Forum, September 7-10, 2025, Salt Lake City, UT

Last Page

S103

DOI

10.1016/j.annemergmed.2025.06.254

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