After fall from standing, negative torso exam suggests no CT needed

  • Injury

  • International Clinical Digest
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Takeaway

  • Fall from standing injuries seldom require torso CT.

Why this matters

  • Some advocate for liberal empiric CTs for this population.
    • Elderly patients are often frail and may have distracting injuries.
    • Liberal CT scanning may save time.
  • But this kind of fall is a very low-energy mechanism.
  • Studies have not previously evaluated physical exam’s predictive value in this situation.

Key results

  • Median age of alert patients undergoing CT, 56.5 years.
  • 349 had abdominal CT.
    • 12.5% had injury (43 patients, 54 injuries).
    • 3.7% had intervention (13 patients).
    • 12/13 had positive physical exam.
  • 379 had chest CT. 
    • 32% had injury (121 patients, 179 injuries).
    • 3% had intervention (11 patients).
    • 11/11 had positive physical exam.
  • Negative predictive value of intervention for: 
    • Normal abdominal physical exam: 99.7%.
    • Normal abdominal exam plus normal vitals: 100%.
    • Normal chest physical exam: 100%.
  • 327 abdominal and 320 chest scans could have been avoided, saving $671,255 over 3 years.

Study design

  • 3-year registry review at Level I trauma center (n=1654).
  • Authors examined injuries due to falls from standing among alert patients who underwent chest or abdominal CT or X-ray.
  • Outcome: injury leading to intervention.
  • Funding: None disclosed.

Limitations

  • Retrospective single-centre study.
  • No subgroup analysis of patients taking anticoagulant or antiplatelet agent. 

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