Clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures.

Abstract

To define the role of head computed tomography (CT) scans in the geriatric population with isolated low-energy femur fractures and describe the pertinent clinical variables which are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed. Retrospective review. Level I trauma centre. Eleven hundred ninety-two (1192) patients sustaining a femur fracture following a low-energy fall. Pertinent clinical variables that were associated with CTs that yielded positive findings. Two hundred fifty patients (21%) underwent a head CT scan as part of their evaluation. Of these patients, 83% suffered proximal femur fractures, 11% shaft fractures and 6% distal fractures. The majority of the patients were evaluated by the emergency department (ED) with only 18% (44/250) being evaluated by the trauma team. Average patient age was 83 years (range 65-99 years). One hundred seventy-three patients (69%) were on some form of antiplatelet medication or anticoagulation. Of the 250 patients who underwent head CT scan, 16 (6%) patients had acute findings (haemorrhage - 15, infarct - 1), and none of the patients required neurosurgical intervention. None of the patients with a traumatic injury required a neurosurgical invention after sustaining a low energy fall (0/1192). Head CT scans should have a limited role in the work-up of this patient population and should be reserved for patients with a history and physical findings that support head trauma. Prognostic level III. See instructions for authors for a complete description of levels of evidence.