Department of Geriatric Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
Eur Geriatr Med. 2024 Aug;15(4):1081-1089. doi: 10.1007/s41999-024-01007-9. Epub 2024 Jun 19.
Current guidelines recommend a low threshold for computerized tomography (CT) scanning in older patients presenting with low-energy trauma (LET). With the ageing of the population, this results in increased use of healthcare resources and costs. We aim to assess (1) the number of CT scans performed as part of the initial trauma screening, (2) their traumatic clinical implications, and (3) their non-traumatic clinical implications.
A retrospective study in patients ≥ 70 years presenting at a Dutch trauma centre with a proximal femur fracture following a LET between 2021 and 2022. We collected data concerning demographics, Clinical Frailty Scale, Injury Severity Score, number of CT scans and whether the results of these scans altered clinical management.
We included 278 patients. Median age was 83.0 years (IQR 77.0-89.0), median ISS was 9 (IQR 9-10) and, most common mechanism of injury was a ground level fall (n = 159, 57.2%). In 49 patients (17.6%) one or more CT scans were performed. These scans did not reveal co-existing traumatic injuries altering clinical management. In 2 patients (0.7%) incidental findings were found that immediately affected treatment.
Our study concludes that (1) approximately one in five patients with a proximal femur fracture received a CT scan as part of the initial trauma screening, resulting in (2) no traumatic and (3) minimal non-traumatic clinical implications. Therefore, a restrictive policy can be justified in patients with no additional clinical signs or symptoms and admission to the hospital. Further prospective research would be valuable to confirm our results.
目前的指南建议对低能量创伤（LET）就诊的老年患者进行计算机断层扫描（CT）检查的门槛较低。随着人口老龄化，这导致医疗资源和成本的增加。我们旨在评估（1）作为初始创伤筛查一部分进行的 CT 扫描数量，（2）其创伤性临床意义，和（3）其非创伤性临床意义。
这是一项回顾性研究，纳入了 2021 年至 2022 年期间在荷兰一家创伤中心就诊的年龄≥70 岁、因 LET 导致股骨近端骨折的患者。我们收集了人口统计学、临床虚弱量表、损伤严重程度评分、CT 扫描数量以及这些扫描结果是否改变临床管理的数据。
我们纳入了 278 名患者。中位年龄为 83.0 岁（IQR 77.0-89.0），中位 ISS 为 9（IQR 9-10），最常见的损伤机制是地面水平跌倒（n=159，57.2%）。49 名患者（17.6%）进行了一次或多次 CT 扫描。这些扫描未发现改变临床管理的合并创伤性损伤。在 2 名患者（0.7%）中发现了偶然发现，这立即影响了治疗。
我们的研究表明，（1）约五分之一的股骨近端骨折患者在初始创伤筛查中接受了 CT 扫描，导致（2）无创伤性和（3）极小的非创伤性临床意义。因此，可以对没有额外临床体征或症状且入院的患者实行限制政策。进一步的前瞻性研究将有助于证实我们的结果。
