Head computed tomography scans in elderly patients with low velocity head trauma after a fall

Zvi Shimoni, Vendi Danilov, Shoshana Hadar, Paul Froom

Research output: Contribution to journalArticlepeer-review


Background: Recommendations for a head computed tomography (CT) scan in elderly patients without a loss of consciousness after a traumatic brain injury and without neurological findings on admission and who are not taking oral anticoagulant therapy, are discordant. Objectives: To determine variables associated with intracranial hemorrhage (ICH) and the need for neurosurgery in elderly patients after low velocity head trauma Methods: In a regional hospital, we retrospectively selected 206 consecutive patients aged ≥ 65 years with head CT scans ordered in the emergency department because of low velocity head trauma. Outcome variables were an ICH and neurological surgery. Independent variables included age, sex, disability, neurological findings, facial fractures, mental status, headache, head sutures, loss of consciousness, and anticoagulation therapy. Results: Fourteen patients presented with ICH (6.8%, 3.8- 11.1%) and three (1.5%, 0.3-4.2%) with a neurosurgical procedure. One patient with a coma (0.5, 0.0-2.7) died 2 hours after presentation. All patients who required surgery or died had neurological findings. Reducing head CT scans by 97.1% (93.8-98.9%) would not have missed any patient with possible surgical utility. Twelve of the 14 patients (85.7%) with an ICH had neurological findings, post-trauma loss of consciousness or a facial fracture were not present in 83.5% (95% confidence interval 77.7-88.3) of the cohort. Conclusions: None of our patients with neurological findings required neurosurgery. Careful palpation of the facial bones to identify facial fractures might aid in the decision whether to perform a head CT scan.

Original languageEnglish
Pages (from-to)359-363
Number of pages5
JournalIsrael Medical Association Journal
Issue number7
StatePublished - Jun 2021


  • Computed tomography (CT) brain imaging
  • Elderly
  • Facial fracture
  • Intracranial hemorrhage
  • Traumatic brain injury (TBI)


Dive into the research topics of 'Head computed tomography scans in elderly patients with low velocity head trauma after a fall'. Together they form a unique fingerprint.

Cite this