Pierre-Jean Pages1, Marie-Paule Boncoeur-Martel2, François Dalmay3, Henri Salle4, François Caire5, Charbel Mounayer6, Aymeric Rouchaud7. 1. Limoges university hospital, Department of radiology, 87000 Limoges, France. Electronic address: pierre.jean.pages@gmail.com. 2. Limoges university hospital, Department of radiology, 87000 Limoges, France. Electronic address: marie-paul.boncoeur-martel@chu-limoges.fr. 3. Limoges university hospital, Department of Biostatististics, 87000 Limoges, France. Electronic address: francois.dalmay@unilim.fr. 4. Limoges university hospital, Department of neurosurgery, 87000 Limoges, France. Electronic address: henri.salle@chu-limoges.fr. 5. Limoges university hospital, Department of neurosurgery, 87000 Limoges, France. Electronic address: francois.caire@chu-limoges.fr. 6. Limoges university hospital, Department of radiology, University Limoges, CNRS, XLIM, UMR 7252, 87000 Limoges, France. Electronic address: charbel.mounayer@chu-limoges.fr. 7. Limoges university hospital, Department of radiology, University Limoges, CNRS, XLIM, UMR 7252, 87000 Limoges, France. Electronic address: aymeric.rouchaud@gmail.com.
Abstract
OBJECTIVES: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVES: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Barbara Resnick; Sheryl Zimmerman; Joseph Gaugler; Joseph Ouslander; Kathleen Abrahamson; Nicole Brandt; Cathleen Colón-Emeric; Elizabeth Galik; Stefan Gravenstein; Lona Mody; Philip D Sloane; Kathleen Unroe; Hilde Verbeek Journal: J Am Geriatr Soc Date: 2022-02-23 Impact factor: 5.562
Authors: Barbara Resnick; Sheryl Zimmerman; Joseph Gaugler; Joseph Ouslander; Kathleen Abrahamson; Nicole Brandt; Cathleen Colón-Emeric; Elizabeth Galik; Stefan Gravenstein; Lona Mody; Philip D Sloane; Kathleen Unroe; Hilde Verbeek Journal: J Am Med Dir Assoc Date: 2022-03 Impact factor: 7.802
Authors: T Kania; S Pandya; S Demissie; D Abdelhalim; C Governo; S Hawkins; D Younan; K Atanassov; A Gave Journal: Ann Med Surg (Lond) Date: 2022-08-27