CT Brain Utilization After Low-Risk Head Injury in Adults: A Retrospective Cohort Study and Literature Review

Introduction Falls in adults aged ≥65 years contribute substantially to emergency department presentations and mild traumatic brain injury, with variable risk of intracranial hemorrhage. Existing CT decision tools often exclude older adults, resulting in potentially unnecessary imaging. This study aimed to identify predictors of intracranial pathology in all adults and compare older versus younger patients to inform a future prospective study. Materials and methods In preparation for a prospective study, we performed a retrospective imaging-selected cohort study analyzing all CT brain studies performed for suspected head injury between June and August 2024. Patients under 18 years and those undergoing imaging for non-traumatic indications were excluded. Clinical variables, including GCS, premorbid function, and anticoagulation status, were extracted for analysis. Logistic regression was employed to assess associations with intracranial pathology, with odds ratios and 95% CIs calculated, and statistical significance determined using a Wald test (p < 0.05). Results A total of 110 patients were included in this study, with a median age of 73.5 years (IQR 43.5-82.0). Positive CT brain findings were identified in 9 (8.2%) patients. Anticoagulation status demonstrated a statistically significant association with positive CT findings (p = 0.047). Conclusions In adults presenting after a fall, anticoagulation, older age, and new neurological deficits emerged as potential indicators of intracranial pathology, while vomiting and suspected skull fracture showed weaker associations. The small number of CT-positive cases and imaging-selected cohort limit precision and preclude assessment of decision-rule performance. These hypothesis-generating findings will inform a prospective study and the development of a predictive framework to guide safer, more targeted cranial imaging in older adults.