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

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.