Limoges university hospital, Department of radiology, 87000 Limoges, France.
Limoges university hospital, Department of Biostatististics, 87000 Limoges, France.
J Neuroradiol. 2020 Feb;47(1):54-58. doi: 10.1016/j.neurad.2019.03.004. Epub 2019 Apr 2.
Fall of the elderly person is a public health problem. The objectives of our study were to evaluate the relevance of systematically performing in emergency a computed tomography (CT) scan for fall in the elderly person, to identify specific criteria predicting the appearance of lesions.
We performed a retrospective analysis of 500 consecutive patients aged 65 and over, who underwent an emergency head CT scan for fall from their height. Outcome at the end of the acute care, clinico-biological data and delays between trauma an d CT were collected, and crossed with a detection of head lesion on the CT scan.
Of 500 patients, 38 (7.6%) had traumatic lesions depicted on the CT scan and 267 (53.4%) were hospitalized after the CT scan. Three (0.6%) had been operated for urgent head surgery. Nine of the 38 (23.6%) patients with traumatic lesion returned home. Presence of a lesion depicted on the CT scan was not correlated with the orientation of the patient (P < 0.0001). Post-traumatic injury was significantly associated with male sex (RR = 2.19, P = 0.0217), consciousness impairment (RR = 1.56, P < 0.0001), focal neurological deficit (RR = 6.36, P = 0.0362) and past history of post-traumatic brain injury (RR = 7.17, P = 0.0027). Anticoagulant therapy was not associated with increased risk of traumatic lesions (P = 0.3315). ROC analysis determined that a 5-hours time-interval between head trauma and CT allowed optimal detection of lesions.
The systematic indication of an emergency head CT scan for fall in elderly patients presents a low diagnostic and therapeutic yield and is not relevant. Male sex, consciousness impairment, focal neurological deficit, past history of post-traumatic brain injury and time-interval between head trauma and CT are statistically related to the presence of lesions and should therefore be taken into account.
老年人跌倒属于公共卫生问题。本研究旨在评估老年人跌倒后急诊行计算机断层扫描（CT）的相关性，以确定预测损伤出现的具体标准。
我们对 500 例年龄在 65 岁及以上、因从高处坠落而接受急诊头部 CT 检查的连续患者进行了回顾性分析。收集了急性护理结束时的临床生物数据和创伤与 CT 之间的时间延迟，并与 CT 扫描上的头部病变检测结果进行交叉分析。
500 例患者中，38 例（7.6%）CT 扫描显示有创伤性病变，267 例（53.4%）在 CT 扫描后住院。3 例（0.6%）患者因紧急颅脑手术而接受了手术。38 例有创伤性病变的患者中，9 例（23.6%）回家。CT 扫描上是否存在病变与患者的体位无关（P < 0.0001）。创伤后损伤与男性（RR=2.19，P=0.0217）、意识障碍（RR=1.56，P < 0.0001）、局灶性神经功能缺损（RR=6.36，P=0.0362）和创伤性脑损伤史（RR=7.17，P=0.0027）显著相关。抗凝治疗与创伤性病变风险增加无关（P=0.3315）。ROC 分析确定，头部创伤与 CT 之间 5 小时的时间间隔可最佳检测病变。
系统指示对老年跌倒患者进行急诊头部 CT 检查的诊断和治疗效果不佳，因此不相关。男性、意识障碍、局灶性神经功能缺损、创伤性脑损伤史和头部创伤与 CT 之间的时间间隔与病变的存在具有统计学相关性，因此应予以考虑。
