• Tanya Mellett, Courtney West, Theophilus I Emeto, Jane Dutson, Angeline Khoo, and Vinay Gangathimmaiah.
• Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia.
• Emerg Med Australas. 2024 Dec 5.

ObjectiveOur primary aim was to identify a low-risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT).MethodsThis was a single-site, prospective, observational, cohort study conducted at a major-referral ED. Alert, haemodynamically stable, older adults with suspected head trauma were eligible. This included both community dwellers and residential aged care facility (RACF) residents. Primary outcome was the proportion of patients who had a clinically important traumatic brain injury (ciTBI) within 42 days of index ED presentation. Secondary outcomes included proportion investigated with a cCT, and proportion needing neurosurgical intervention.ResultsTwo hundred seventy-six patients (mean age 80.5 years; 53.6% female) were enrolled. The most common mechanism of injury was ground-level fall (93.8%). One in four patients was from RACFs, 30.1% had dementia and 52.2% were on blood thinners. 80.8% had a cCT during the index ED visit. Seven (2.5%) patients had ciTBI within 42 days of index ED presentation. Patients with ciTBI had either external signs of head injury or abnormal neurological exam. All patients with ciTBI were treated conservatively after shared decision-making.ConclusionsAlert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs.© 2024 Australasian College for Emergency Medicine.

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