Massachusetts Chapter of the American College of Surgeons

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Re-Thinking the Need and Value of Cross-Sectional Torso Imaging in Trauma Patients who Sustain a Ground-Level Fall and Present with Altered Mental Status: Outcomes from a Level 1 Trauma Center
Brendin R. Beaulieu-Jones, MD, MBA1,2, Max Zhu, BS2, Shamsh Shaik, BS2,Tejal S. Brahmbhatt, MD1,2, Dane Scantling, DO, MPH1,2, Sabrina E Sanchez, MD, MPH1,2
1Department of Surgery, Boston Medical Center, Boston, MA; 2Boston University School of Medicine, Boston, MA

Background: Patients with altered mental status (AMS) are often excluded from studies evaluating computed tomography of the torso (CTT) after ground level falls (GLF). We sought to describe the value of performing CTT in patients with AMS after GLF.
Methods: Single-institution retrospective cohort study of GLF patients (?1 meter) with and without AMS (GCS <15, blood alcohol level >150 , intubation prior to hospital evaluation), 2015-2019. Traumatic injury identification on CTT was evaluated in the context of normal/abnormal torso physical exam (PE) and chest/pelvis radiographs (CXR/PXR).
Results: 1195 patients met inclusion criteria: 344 had AMS, of which 129 (37.5%) had CTT; 851 had normal mental status, of which 180 had CTT. Patients with a normal PE with AMS (N=79) and without AMS (N=38) had a similar rate of new injury discovery on CTT (6.3% vs. 7.9%, p=0.91). Negative PE had a negative predictive value (NPV) for identification of acute traumatic injury of 92.3% in patients with AMS while normal PE, CXR, and PXR had a NPV of 96.0%. Among patients with CTT, patients with AMS had a lower rate of acute traumatic injury on CTT compared to alert patients (32.6% vs. 75.6%, p<0.001). On adjusted multivariate analysis AMS was not associated with likelihood of identifying acute traumatic injury on CTT.
Conclusion: In patients sustaining GLFs who present with AMS and who otherwise have a negative PE, CXR, and PXR, CTT is very unlikely to identify new traumatic injuries. Strong consideration should be given to forego cross-sectional imaging in this patient population.


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