title: Clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma centre.
  
  
  METHODS
  Eleven hundred ninety-two (1192) patients sustaining a femur fracture following a low-energy fall.
  
  
  METHODS
  Pertinent clinical variables that were associated with CTs that yielded positive findings.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Prognostic level III. See instructions for authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA(1).
authors: Hemil
authors: H
authors: Maniar
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA(1).
authors: Kristin
authors: K
authors: McPhillips
authors: Department of Trauma Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2168, USA(2).
authors: Denise
authors: D
authors: Torres
authors: Department of Trauma Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2168, USA(2).
authors: Jeffrey
authors: J
authors: Wild
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA(1).
authors: Michael
authors: M
authors: Suk
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA(1). Electronic address: dshorwitz@geisinger.edu.
authors: Daniel S
authors: DS
authors: Horwitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging*; D006620:Hip Fractures / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D018579:Patient Selection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014193:Trauma Centers; D019564:Unnecessary Procedures
keywords: Geriatric; Head CT; Hip fracture