B. H. Davis1, A. Kaboodrangi1, A. Draper1, M. Gomez1 1Broward Health Medical Center, Trauma/Critical Care, Fort Lauderdale, FL, USA
Introduction: Ground level falls (GLF) account for the majority of traumatic injuries in older adults and these patients are routinely evaluated full body CT “pan scan”. The indication for CT pan-scans in geriatric trauma patients is mixed with some studies demonstrating a benefit for its use, while others showing no impact on outcomes. The purpose of this study is to evaluate the utility of pan-scan compared with selective imaging techniques in geriatric patients who are stable, alert, and experienced a ground-level fall based on hospital LOS, ICU LOS, interventions, and mortality.
Methods: This retrospective study included patients >55 years, Alert and oriented, that sustained a GLF presenting to our level II trauma center from January, 2021 to March, 2022. Variables including age, sex, vitals, chief complaint, home medications, comorbidities, labs, ISS, GCS, injuries, hospital length of stay, ICU length of stay and mortality were collected. Patients were designated as having selective imaging defined as CT brain, cervical spine plus one additional imaging study or being "pan-scanned".
Results: There were 105 patients with selective imaging and 91 patients that were pan-scanned. Patient characteristics were similar between the two groups regarding age, gender, vital signs, lab values, anticoagulation, and comorbidities. The average GCS of patients with selective imaging was 14.65 and 13.68 for patient that were pan-scanned (p = 0.004). The average ISS for selective imaging was 8.6 compared to 9.6 in the pan-scanned group (p=0.34). Selective imaging patients had an average shorter hospital course at 4.5 days compared to 7.1 (p=0.006) days for patients that were pan-scanned. Positive CT-Brain was found in 37% of selective imaging patients vs 30% of pan-scanned patients. Most additional injuries identified (109 selective vs 160 pan-scan) were seen on plain films. There was no statistically significant difference in ICU length of stay or mortality.
Conclusion: Geriatric trauma patients with GLF with selective imaging had shorter hospital stay without a significant difference in ICU length of stay or mortality when compared to pan-scanned patients despite similar ISS. Using clinical picture as a guide for diagnostic imaging reduces the number of unnecessary imaging without compromising patient outcomes and may reduce hospital length of stay.