CT pan-scanning versus targeted imaging among older adults after ground level falls
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 p...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-03-01
|
| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/1/e001534.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | 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. |
|---|---|
| ISSN: | 2397-5776 |