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Radiographic assessment of ground-level falls in elderly patients: Is the "PAN-SCAN" overdoing it?

Abstract：

INTRODUCTION:Routine, whole-body computed tomography imaging (PAN-SCAN) has been shown to identify unexpected injuries and alter the management of patients presenting with blunt trauma. We sought to characterize the changes in practice over time and the utility of PAN-SCAN imaging in elderly patients who fall and require admission to a trauma center. METHODS:We performed a retrospective analysis by using data derived from a Pennsylvania state-wide trauma registry (2007-2010). All hemodynamically stable patients (>65 years) who had a ground-level fall and were admitted for >24 hours were selected. Patients who underwent a combination of all three scans within 2 hours of arrival were considered to have underwent PAN-SCAN imaging. Clinical outcomes were compared across PAN-SCAN patients relative to less diagnostic imaging. Regression analysis was used to determine whether PAN-SCAN imaging was an independent determinate of mortality and resource use. RESULTS:Over the period of study, 13,043 patients met inclusion criteria. The annual rate of PAN-SCAN imaging after ground-level falls increased over time. After we controlled for important confounders, PAN-SCAN imaging was not associated with mortality (odds ratio 0.97, P = .74, 95% confidence interval 0.80-1.18). Despite greater injury severity, PAN-SCAN imaging was independently associated with significantly lesser intensive care unit requirements, step-down days, and a lesser overall duration of stay. CONCLUSION:PAN-SCAN imaging has become more common over time in elderly patients having a ground-level fall. Although PAN-SCAN imaging during the initial trauma evaluation was not associated with an independent decrease in the risk of mortality, it was independently associated with lesser hospital resource use. These data suggest that whole-body computed tomography imaging may benefit trauma center resource use for patients with ground-level falls.

journal_name

Surgery

journal_title

Surgery

authors

Dwyer CR,Scifres AM,Stahlfeld KR,Corcos AC,Ziembicki JA,Summers JI,Peitzman AB,Billiar TR,Sperry JL

doi

10.1016/j.surg.2013.07.015

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

816-20; discussion 820-2

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(13)00417-0

journal_volume

154

pub_type

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Radiographic assessment of ground-level falls in elderly patients: Is the "PAN-SCAN" overdoing it?