Massachusetts Chapter of the American College of Surgeons

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Utility of Torso Imaging for Elderly Patients Sustaining Ground Level Falls
Max Zhu, Mollie O’Brien, Abraham Jaffe, Shamsh P. Shaikh, Abigail Rasch, Tejal S. Brahmbhatt, Sunday Clark, Sabrina E. Sanchez

Computed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department (ED). Some data suggests that older adults (?65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after falls from 1m or less (GLF) at our level 1 trauma center.

Patients ?18 presenting with GLF in 2018-2019 were included. Data was obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging, and results were stratified by age. Multivariate logistic regression was used to compare the rate of abnormal CT imaging between age groups.

194 patients <65 and 298 patients ?65 were included. Older patients were significantly more likely to receive a pelvic radiograph (p<0.001), brain CT (p=0.002), and neck CT (p=0.003), but not torso CT (p=0.262). On multivariate logistic regression, older patients were equally likely as younger patients to have an injury identified by torso CT (OR= 0.72, CI= 0.27-1.9, p= 0.51). A positive physical exam of the torso, however, was strongly associated with positive imaging findings (OR=2.15, CI=1.26-3.67, p=0.005). Other relevant outcomes are summarized in Table 1.

GLF patients <65 and ?65 obtained torso CTs at similar rates. The rate of injury identification was also similar and strongly associated with positive physical exam findings. More conservative use of CT on elderly patients could decrease healthcare utilization costs and minimize radiation exposure.

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