The utility of head CT scans in geriatric patients with hip fractures following a low energy injury mechanism: A retrospective review

Allen, James S.; Ravichandiran, Kajeandra; McLaughlin, Terry-Lyne; Macdonald, Christie A.; Howard, James L.; Lanting, Brent A.; Vasarhelyi, Edward M.

doi:10.1016/j.injury.2020.12.022

Cited by 1 publication

(2 citation statements)

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“…None of these patients required neurosurgical intervention, and only nine (14.5%) of patients with a positive CT head for acute intercranial bleed needed a modification in thromboprophylaxis following surgery. The authors concluded that CT head scans should be reserved for patients with a history or physical examination consistent with head trauma or who are using anticoagulation [22]. Next to brain injury, some studies indicate that older patients who fall from standing height are more prone to injuries of the upper cervical spine [18,33].…”

Section: Discussionmentioning

confidence: 99%

“…Studies concerning the use of CT scans in older trauma patients are mainly performed in the US, where the healthcare system is different compared to most European healthcare systems. In addition, these studies focused solely on the utility of a specific type of CT scan, such as a CT head, and did not take into account the frailty of the studied population, or studied a heterogeneous population, which makes it difficult to generalize the results to daily practice [2,13,[17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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The clinical implications of using a low threshold for computed tomography scans in older patients presenting with a proximal femur fracture

van Westendorp,

Robben,

van Hooft

et al. 2024

Eur Geriatr Med

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Purpose Current guidelines recommend a low threshold for computerized tomography (CT) scanning in older patients presenting with low-energy trauma (LET). With the ageing of the population, this results in increased use of healthcare resources and costs. We aim to assess (1) the number of CT scans performed as part of the initial trauma screening, (2) their traumatic clinical implications, and (3) their non-traumatic clinical implications. Methods A retrospective study in patients ≥ 70 years presenting at a Dutch trauma centre with a proximal femur fracture following a LET between 2021 and 2022. We collected data concerning demographics, Clinical Frailty Scale, Injury Severity Score, number of CT scans and whether the results of these scans altered clinical management. Results We included 278 patients. Median age was 83.0 years (IQR 77.0–89.0), median ISS was 9 (IQR 9–10) and, most common mechanism of injury was a ground level fall (n = 159, 57.2%). In 49 patients (17.6%) one or more CT scans were performed. These scans did not reveal co-existing traumatic injuries altering clinical management. In 2 patients (0.7%) incidental findings were found that immediately affected treatment. Conclusion Our study concludes that (1) approximately one in five patients with a proximal femur fracture received a CT scan as part of the initial trauma screening, resulting in (2) no traumatic and (3) minimal non-traumatic clinical implications. Therefore, a restrictive policy can be justified in patients with no additional clinical signs or symptoms and admission to the hospital. Further prospective research would be valuable to confirm our results.

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Section: Discussionmentioning

confidence: 99%