Brown et al developed a simple risk score to help identify an adult who may benefit from brain imaging following a fall with confusion. This can help to reduce unnecessary testing. The authors are from NHS Tayside and Ninewells Hospital in Dundee, UK.
Patient selection: adult 42 to 97 years of age with median age 74.8 years
Parameters:
(1) atrial fibrillation
(2) history of falls
(3) trauma to face and/or scalp
(4) new focal neurological signs
(5) history of warfarin therapy
(6) dementia
(7) Glasgow coma score (GCS)
|
Parameter |
Finding |
Points |
|
atrial fibrillation |
absent |
0 |
|
|
present |
1 |
|
history of falls |
no |
0 |
|
|
yes |
1 |
|
trauma to face/scalp |
absent |
0 |
|
|
present |
1 |
|
new focal neurological signs |
no |
3 |
|
|
yes |
1 |
|
history of warfarin therapy |
absent |
0 |
|
|
present |
1 |
|
dementia |
no |
0 |
|
|
yes |
-1 |
|
Glasgow coma score |
14 or 15 |
0 |
|
|
3 to 13 |
1 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -1
• maximum score: 8
• A score >= 3 is an indication for ordering brain imaging studies.
Performance:
• The sensitivity was 83% and specificity of 89%.
• The negative predictive value was 96%
• The area under the ROC curve was 0.83.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
