Maryland pearls post about a recent paper in JEM about patients coming in with uncertain head trauma.

1. Subscribe to the Maryland pearls if you don’t already
2. Do not automatically go scan every geriatric patient who might have hit their head. But consider it on a patient to patient basis.

While the unknown patients had a lower % of positive head CT, it was not negligible. See the description below:

In this prospective study looking at geriatric patients with unknown head injury vs. known head injury, the unknown head injury group had an ICH 1.5%, neurosurgical intervention 0.3% and delayed ICH 0.1% when compared to known head injury (10.5%,  1.2% and 0.7% respectively).  The authors concluded that the risk of ICH was high enough in uncertain head injury patients to warrant scanning.

Turchiaro ML Jr, Solano JJ, Clayton LM, Hughes PG, Shih RD, Alter SM. Computed Tomography Imaging of Geriatric Patients with Uncertain Head Trauma. J Emerg Med. 2023 Dec;65(6):e511-e516. doi: 10.1016/j.jemermed.2023.07.009. Epub 2023 Jul 26. PMID: 37838489.