Variability in head computed tomography use for minor head injury after ground-level falls in the emergency department: A subanalysis of EPI-TC study

Xavier Dubucs, Frederic Balen, Pierre-Hugues Cormicael, Axel Benhamed, Valérie Boucher, Éric Mercier, Sandrine Charpentier, Marcel Émond, IRU EPI-TC group

Abstract

The aim of this study was to assess the variation in the use of head computed tomography (CT) scan in patients attending EDs with ground-level fall-related minor head injury. Secondary objectives were: i) to measure the prescription rate of appropriate head CT scan, ii) to identify patients’ and EDs characteristics associated with head CT scan prescription.

Introduction

Traumatic Brain Injury (TBI) is a common cause of admission to Emergency Departments (ED) and most of them are classified as mild TBI [1]. Non-contrast head computed tomography (CT) scan is the gold standard in TBI to detect traumatic Intracranial Hemorrhage (ICH). However, recent studies have shown an overuse of head CT scan up to 15%in case of mild TBI [2].

Materials and methods

This was a planned sub-analysis of a prospective observational cohort study that collected patients’ data over a three-day period (from 06/03/2023 8:00 am to 09/03/2023 8:00 am, continuously H24) in March 2023 across 71 French EDs [12].

Results

A total of 631 patients admitted in one of the 63 participating EDs for head injury after ground-level fall were included (Fig 1). Median age was 79 years (63–88); environmental falls were the leading precipitating factor and more than half of patients (60.5%) had no post TBI symptoms.

Discussion

These results showed a wide variability in the use of CT scan among patients admitted to the ED after ground-level fall-related minor head injury. Our study suggests that this variation is not explained by patients’ characteristics. Several hypotheses may explain these findings. First of all, we assume that national guidelines on the use of head CT scan for patients admitted to ED with mild TBI are not always applied [13].

Conclusions

Head CT scan use in patient presenting to EDs with head injuries after ground-level falls is highly variable. High rate of head CT scan use is not correlated with high traumatic intracranial hemorrhage yield rate.

Citation: Dubucs X, Balen F, Cormicael P-H, Benhamed A, Boucher V, Mercier É, et al. (2026) Variability in head computed tomography use for minor head injury after ground-level falls in the emergency department: A subanalysis of EPI-TC study. PLoS One 21(1): e0334541. https://doi.org/10.1371/journal.pone.0334541

Editor: Jan Chrusciel, Centre Hospitalier de Troyes, FRANCE

Received: May 27, 2025; Accepted: September 29, 2025; Published: January 2, 2026

Copyright: © 2026 Dubucs et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: This study was funded by the Société Française de Médecine d’Urgence (French Society of Emergency Medicine) through the URI-2023 Research Network (Initiatives de Recherche aux Urgences 2023 to X.D). There was no additional external funding received for this study. All the funding or sources of support received during this study had no role in the design, data collection, data analysis, and reporting of this study.

Competing interests: The authors have declared that no competing interests exist.