Is the new orleans criteria for head ct useful for inpatient falls?
Joshi S, Cerasale M, Heidemann D, Yarlagadda J, Rana S, and Jeffries II J. Is the new orleans criteria for head ct useful for inpatient falls? J Hosp Med 2017; 12(s2)
J Hosp Med
Background: Inpatient falls are a patient safety concern in all healthcare facilities. There is currently limited data on the utility of head computed tomography (CT) for inpatient falls. The New Orleans Criteria (NOC) is a validated tool used to determine the appropriateness of neuroimaging in the emergency department after sustaining a fall with minor head injury. The NOC include minor head injury with one of the following; headache, vomiting, age above 60, drug or alcohol intoxication, anterograde amnesia, trauma above the clavicles, and seizure activity. The aim of this study was to evaluate the significance of inpatient falls and determine if the NOC could be applied to triage these patients. Methods: This study is a retrospective review of inpatient falls from a multi-center health system, which includes an urban tertiary teaching hospital, 3 suburban community hospitals, 1 inpatient psychiatric facility and 1 inpatient rehab. Patient safety data was queried for all inpatient falls, classified as with injury, from May 1, 2015 through April 30, 2016. Encounters were manually reviewed for demographic data, circumstances of fall, laboratory results, components of NOC, CT head orders and results. Outcomes of interest include a head CT with any abnormal findings or an acute intracranial process. Results: Inpatient falls over the 1-year period totaled 332. Of the cases reviewed, 57% received a head CT after sustaining a fall. There were 12 (3.6%) CTs that showed a significant finding, and of those 7 (2.1%) had an acute intracranial process. No patients required surgical intervention or had a fatality related to the fall. Details of each fall case with an acute intracranial process are listed in Table 1. 250 (75.3%) patients met at least 1 component of the NOC, with 161 (64.6% of NOC positive) receiving a head CT. The NOC was positive in 6 of the 7 cases, with the missing case having a significant coagulopathy. Test characteristics of the NOC with and without the addition of coagulopathy for acute intracranial process are listed in Table 2. Conclusions:
The NOC has been demonstrated as an effective tool in the emergency room; however, based on our findings its utility to evaluate potential intracranial injury in patients with in-hospital falls is limited. Adding additional criteria to the NOC can improve its test characteristics, but was unable to achieve both high specificity and sensitivity. Further investigation is required to develop a method to appropriately triage patients with in-hospital falls for significant neurological injury.