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