The clinical implications of using a low threshold for computed tomography scans in older patients presenting with a proximal femur fracture

TL;DR

This study finds that using a low threshold for CT scans in older patients with hip fractures from minor injuries leads to few clinical benefits and suggests a more restrictive approach.

Contribution

The study challenges current guidelines by showing minimal clinical benefit from routine CT scans in this specific patient group.

Findings

Approximately 17.6% of patients received CT scans, but none revealed traumatic injuries affecting management.

Only two patients had non-traumatic findings that changed treatment.

A restrictive CT scan policy is recommended for older patients without additional symptoms.

Abstract

We evaluated the number of computerized tomography (CT) scans performed as well as the traumatic and non-traumatic clinical implications of using a low threshold for performing CT scans as part of the initial trauma screening in older patients presenting at the ED with a proximal femur fracture following a low-energy trauma (LET).

Approximately one in five patients received a CT scan as part of the trauma screening in older patients with a proximal femur fracture after a LET. Results show no traumatic clinical implications, two non-traumatic clinical implications, and two initially missed injuries.

In this subgroup of older trauma patients admitted with a proximal femur fracture, a restrictive policy can be used instead of using a low threshold for CT scans as part of the initial trauma screening at the emergency department (ED).

The online version contains supplementary material available at 10.1007/s41999-024-01007-9.

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.

The online version contains supplementary material available at 10.1007/s41999-024-01007-9.

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