Macmillan Mark Thomas, Kirkbride Rachael, Teh Hui Yen, Bott James, Algeo Charlotte, Hay Christopher, Stenhouse Gregor J A
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
Department of Interventional Radiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
Br J Radiol. 2025 Jun 1;98(1170):913-919. doi: 10.1093/bjr/tqaf070.
Trauma in the elderly is associated with high mortality. Elderly people who have suffered low impact trauma, such as fall from standing (FFS) are believed still to be at high risk of injury. Whole body trauma CT (WBCT) is increasingly used to image such people, to prevent missing injuries which are not detected clinically. This study aims to assess the utility of WBCT in assessing elderly people who have suffered FFS.
Over a 2-year period in a single health board, data were collected retrospectively for all patients that underwent WBCT. Data were collected on the mechanism, pattern of injury, and outcomes including 30-day mortality using clinical records. Comparison was made between pre-CT clinical suspicion and injury found on WBCT to identify discrepancies.
In total, 460 patients were included in this study. Compared with FFS, fall from more than standing was associated with higher adjusted odds of having an injury out with zone of clinical suspicion (Adjusted Odds Ratio (AOR) 2.80, 95% CI 1.23-7.28; P = .021). There was no significant difference in 30-day mortality between patients who had an injury on WBCT and those without.
FFS is associated with a reduced risk of injury out with areas of clinical concern when compared with fall from greater than standing. As such, a targeted approach to CT scanning in these patients could be considered.
This study challenges the current prevailing dogma for the requirement of WBCT in elderly people who suffer FFS, providing evidence that such people have a low risk of injuries out with areas of clinical suspicion.
老年人创伤与高死亡率相关。遭受低冲击力创伤的老年人，如从站立位跌倒（FFS），仍被认为有很高的受伤风险。全身创伤CT（WBCT）越来越多地用于对这类人群进行成像，以防止漏诊临床未发现的损伤。本研究旨在评估WBCT在评估遭受FFS的老年人中的效用。
在一个单一卫生委员会的2年时间里，对所有接受WBCT检查的患者进行回顾性数据收集。使用临床记录收集有关损伤机制、损伤模式和包括30天死亡率在内的结果的数据。比较CT检查前的临床怀疑与WBCT上发现的损伤，以识别差异。
本研究共纳入460例患者。与FFS相比，从高于站立位跌倒与临床怀疑区域外受伤的调整后优势比更高（调整优势比（AOR）2.80，95%置信区间1.23 - 7.28；P = 0.021）。WBCT上有损伤的患者与无损伤的患者在30天死亡率上无显著差异。
与从高于站立位跌倒相比，FFS在临床关注区域外受伤的风险较低。因此，可以考虑对这些患者采用有针对性的CT扫描方法。
本研究对目前关于遭受FFS的老年人需要进行WBCT检查的主流观点提出了挑战，提供了证据表明这类人群在临床怀疑区域外受伤的风险较低。
