CT pan-scanning versus targeted imaging among older adults after ground level falls.

Abstract

Background: Ground level falls (GLFs) among older adults are responsible for millions of injuries. Routine pan-scanning (CT imaging of the head, chest, abdomen and pelvis) is commonly employed; however, we lack robust evidence of its benefit. We investigated whether pan-scanning identifies a larger proportion of patients with significant injury or injury requiring procedural intervention and hypothesized resuscitation area findings-including radiographs, ultrasound, and external signs of injury-would detect these injuries.

Methods: We queried our institutional trauma registry data for patients ≥65 years presenting to our level 1 trauma center after GLFs. Our primary outcome was injury requiring procedural intervention. LASSO (least absolute shrinkage and selection operator) regression models were fit using cross-validation to identify predictors of significant injury to the head, chest, and pelvis/lower extremity from patient characteristics and resuscitation area findings.

Results: 598 patients were included, among whom 17% underwent pan-scan. External signs of injury were associated with increased odds of significant injury in the head (OR 1.12; 95% CI 1.08 to 1.16), chest (OR 1.50; 95% CI 1.45 to 1.46), and extremity/pelvis (OR 1.07; 95% CI 1.04 to 1.10). Chest (OR 1.18; 95% CI 1.14 to 1.23) and pelvic X-ray (OR 1.36; 95% CI 1.33 to 1.40) were also associated with increased odds of significant injury. 17 patients required procedural interventions for head injuries and 2 for the chest. No patients had a significant injury requiring any procedures for the abdomen.

Conclusions: Our study suggests resuscitation area findings may direct targeted imaging in the chest and abdomen/pelvis, but whether individual risk and institutional burden associated with pan-scanning is outweighed by its ease requires further study.

Level of evidence study type: Prognostic and Epidemiological, Level IV.