Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen

Methodology: 3.5/5
Usefulness: 3.5/5

CMAJ. 2023 Dec 3;195(47):E1614-E1621. de Wit K, et al. doi: 10.1503/cmaj.230634.

Question and Methods: The Falls Decision Rule was derived to identify older adults with fall who do not require CT to rule out intracranial bleeding, using logistic regression.
Findings: The rule demonstrated 98.6% sensitivity and 20.3% specificity for detecting significant intracranial bleeding while allowing a 20% reduction for all patients with falls.
Limitations: Key limitations include the need for external validation, potential bias from low positive outcome rates, low specificity resulting in false positives, smaller than anticipated sample size, and reliance on patient follow-up within the same hospital network.

Interpretation: The Falls Decision Rule has the potential to improve patient safety or ED efficiency depending on the current practice pattern.

By Dr. Heather Moffatt

JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy

Authors

Heather Moffatt

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Hans Rosenberg

Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
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Venkatesh Thiruganasambandamoorthy

Dr. Venkatesh Thiruganasambandamoorthy is an attending physician and associate scientist at the Ottawa Hospital and Ottawa Hospital Research Institute with an particular interest in syncope and presyncope care.
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