This retrospective cohort study examined whether multivariable risk stratification could meaningfully reduce head CT utilization in patients aged ≥75 years presenting to the ED with mild traumatic brain injury (GCS 13–15), using data from 3,088 consecutive patients seen between 2019 and 2022.
Among patients ≥75 years (54.7% of the cohort, CT performed in 98.2%), the prediction model showed only moderate discrimination (optimism-corrected AUC 0.693; 95% CI 0.610–0.775). At 100% sensitivity, CT use could be reduced by just 1.5%; at 99% sensitivity, by only 10.6%.
Single-center retrospective design limits generalizability; the model was internally validated only (bootstrap), with no external validation cohort; the publisher page indicates full text was not available, so additional methodological details may be missing.
For patients aged ≥75 with mTBI, clinical decision rules offer very limited ability to safely skip CT — clinicians should not rely on risk stratification tools to rule out imaging in this age group, as the potential CT reduction is minimal even at 99% sensitivity.
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