Clinical Indications of Computed Tomography (CT) of the Head in Patients With Low-Energy Geriatric Hip Fractures: A Follow-Up Study at a Community Hospital
| Autor: | Terrence J. Endres, Kris Danielson, Clifford B. Jones, Deb Sietsema, Teresa Hall |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Computed tomography lcsh:Geriatrics Article 03 medical and health sciences Injury Severity Score 0302 clinical medicine lcsh:Orthopedic surgery Geriatric trauma medicine Glasgow Coma Scale Orthopedics and Sports Medicine Femur 030222 orthopedics Hip fracture medicine.diagnostic_test business.industry Rehabilitation head CT scan medicine.disease Community hospital Work-up lcsh:RD701-811 lcsh:RC952-954.6 hip fracture 030220 oncology & carcinogenesis Surgery geriatric trauma Radiology Geriatrics and Gerontology business |
| Zdroj: | Geriatric Orthopaedic Surgery & Rehabilitation, Vol 10 (2019) Geriatric Orthopaedic Surgery & Rehabilitation |
| ISSN: | 2151-4593 |
| Popis: | Introduction: A seemingly large percentage of geriatric patients with isolated low-energy femur fractures undergo a head computed tomography (CT) scans during initial work up in the emergency department. This study aimed to evaluate the pertinent clinical variables that are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed. Methods: A retrospective review performed at a level II trauma center including 713 patients over the age of 65 sustaining a femur fracture following a low-energy fall. The main outcome measure was pertinent clinical variables that are associated with CT scans that yielded positive findings. Results: A total of 713 patients over the age of 65 were included, with a low-energy fall, of which 76.2% (543/713) underwent a head CT scan as part of their evaluation. The most common presenting symptom reported was the patient hitting their head, 13% (93/713), and 1.8% (13/713) were unsure if they had hit their head. Of those evaluated with a head CT scan, only 3 (0.4%) had acute findings and none required acute neurosurgical intervention. All three patients with acute changes on the head CT scan had an Injury Severity Score (ISS) greater than 9, Glasgow Coma Scale (GCS) less than 15, and evidence of trauma above the clavicles. Discussion: None of the patients with a traumatic injury required a neurosurgical intervention after sustaining a low-energy fall (0/713). Conclusion: Head CT scans should have a limited role in the workup of this patient population and should be reserved for patients with a history and physical exam findings that support head trauma, an ISS > 9 and GCS < 15. |
| Databáze: | OpenAIRE |
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