# A Clinical Audit of the Use of CT Head Scan Post-Inpatient Falls in Hospitalised Older Adults Utilising a Post-Fall Clinical Pathway

## TL;DR

This study examines how CT head scans are used after falls in older hospitalized patients and finds that guidelines are not consistently followed.

## Contribution

The study provides insights into the real-world application of a clinical pathway for CT scans after falls in older adults.

## Key findings

- Only 50.1% of patients meeting CT scan criteria received a scan, despite 90.6% fulfilling the pathway criteria.
- Serious head injuries were rare, occurring in 2.25% of falls, with subdural haematoma being the most common.
- No missed serious injuries were identified, but clinical judgment often overrode pathway guidelines.

## Abstract

Background: Older adults are at high risk of falls, and head injuries following these events can have devastating consequences. The In-Patient Post Fall Clinical Pathway is a tool utilised in many hospitals in Queensland, Australia, to guide the need for CT brain imaging post-inpatient fall. This audit aimed to assess the use of CT imaging following inpatient falls in older adults, evaluate adherence to the In-Patient Post Fall Clinical Pathway, and explore factors associated with serious head injury. Methods: A retrospective audit was conducted across two regional Queensland hospitals over 2.5 years. Falls involving patients aged over 65 years were included. Data were analysed using descriptive and bivariate statistical tests. Results: Among 874 eligible falls, the mean patient age was 80.4 years, and approximately two-thirds were male. While 90.6% of patients who had fallen met clinical pathway criteria for a CT head scan, only 50.1% of them received a scan. Serious head injuries were uncommon (2.25% of total falls), with subdural haematoma being most frequent. Only one patient underwent neurosurgical intervention. No missed serious injuries were identified. No individual characteristic was significantly associated with serious head injury, although trends were observed for unwitnessed falls, falls from bed, falls with a head strike, new symptoms four hours post-fall, and anticoagulant use. Conclusions: There is a gap between clinical pathway recommendations and imaging practices, with clinicians often relying on judgement over strict adherence to guidelines. Further research is needed to inform evidence-based and practical decision-making to balance imaging use with clinical risk.