Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2023 Feb;35(1):41-47. doi: 10.1111/1742-6723.14051. Epub 2022 Jul 25.
To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post-fall. To describe rates of CT brain (CTB) performance, intracranial trauma-related findings, neurosurgical intervention, and patient outcome.
Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made.
Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23-30] vs 20% [95% CI 15-25], P < 0.001) and anticoagulant use (59% [95% CI 55-63] vs 42% [95% CI 37-49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma-related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup.
Just over half of the RACF to ED transfers were classified as 'potentially avoidable'.
确定潜在可预防的住家养老院（RACF）因跌倒后潜在颅内损伤而转至急诊（ED）的比例。描述 CT 脑（CTB）检查的执行率、颅内创伤相关发现、神经外科干预和患者结局。
从医院电子病历中获取患者名单，筛选合格者并提取数据。潜在可预防定义为：（1）RACF 在 ED 就诊 24 小时内返回，无论 CTB 检查结果如何；（2）ED 管理在 RACF 合理进行。比较执行 CTB 与未执行 CTB 的患者，包括颅面外伤的外部征象、抗凝药物使用、基线认知障碍和存在高级护理指令（ACD）。
在 784 名患者中，415 名（53%）被归类为潜在可避免的。其中 314 名（76%）进行了 CTB 检查。在所有 784 名患者中，538 名（69%）进行了 CTB 检查。CTB 更可能与颅面外伤的外部征象（26% [95% CI 23-30] 比 20% [95% CI 15-25]，P<0.001）和抗凝药物使用（59% [95% CI 55-63] 比 42% [95% CI 37-49]，P<0.001）有关，但与认知障碍或 ACD 无关。在 538 例 CTB 中，31 例（6%）患者存在急性与颅内创伤相关的发现，所有患者均接受保守治疗。11 例（1%）死亡患者均不在潜在可预防亚组中。
超过一半的 RACF 转至 ED 的情况可归类为“潜在可避免”。
