title: Torso Computed Tomography Can Be Bypassed after Thorough Trauma Bay Examination of Patients Who Fall from Standing.
abstract: Reliance on CT imaging in the evaluation of low-impact blunt trauma is a major source of radiation exposure, cost, and resource utilization. This study sought to determine if torso (chest and abdomen) CT could be avoided in patients with ground level falls. This was a retrospective chart review of patients admitted to the trauma service between January 2013 and April 2014. The mechanism of injury was ground level fall or fall from sitting. Patient demographics, physical examination (PE) findings, imaging results, length of stay, and complications were reviewed. History and physical data were based on chief resident or attending documentation. A significant thoracic injury was defined as a hemothorax, a pneumothorax, greater than three rib fractures, or aortic injury. A significant abdominal injury was defined as a solid organ injury, an intra-abdominal hematoma, a hollow viscus injury, aortic injury, or a urologic injury. The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS) < 13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Kedar S
authors.initials: KS
authors.lastname: Lavingia
authors.forename: Jay N
authors.initials: JN
authors.lastname: Collins
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soult
authors.forename: W Helman
authors.initials: WH
authors.lastname: Terzian
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Weireter
authors.forename: L D
authors.initials: LD
authors.lastname: Britt
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D061214:Patient Safety; D010808:Physical Examination / Q000379:methods; D011187:Posture; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal / Q000191:economics / Q000706:statistics & numerical data; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D014193:Trauma Centers; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*; D014768:Virginia; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging*