There is little difference in the investigation of injuries between younger and older patients except perhaps for a lower threshold for imaging – especially CT in minor head trauma, of c-spine, and of hip and pelvis in someone with change in weight bearing (eg new severe hip pain even if weight bearing.) The potential benefits of diagnosing occult injuries far outweigh the long-term consequences of added radiation exposure. There are NO long-term consequences of radiation exposure in this age group.
There is currently no body of evidence to guide decisions around imaging and treatment of head injuries. The Canadian Head CT Rules (link to PDF Poster and scholarly article) suggest that everyone over 65 with even minor head trauma is a candidate for CT imaging. Clearly some clinical judgement is required. However the standard of care is difficult to establish.
Good practice is…
Even with a normal CT, a late subdural or developing contusion is quite possible.
Even with a normal physical exam, a late subdural or developing contusion is quite possible.