Background: CT pan-scans have become increasingly commonplace as part of the initial diagnostic work-up for patients sustaining traumatic injuries. They have proven effective in improving diagnostic accuracy in those with high energy mechanisms of injury. However, the utility of pan-scans in the geriatric population sustaining low energy traumatic injuries remains unproven. There is no study that assesses the usefulness of CT pan-scans in patients who sustain injuries related to osteoporosis, also known as fragility fractures.
Methods: A retrospective review was conducted of patients who sustained a fragility fracture at a Level 1 trauma center over a 15-month period. Patients underwent CT pan-scans at the discretion of the trauma surgery or emergency medicine teams. Radiologist interpretations of the CT pan-scans were reviewed for acute findings, and charts were reviewed for resulting changes in both orthopedic and non-orthopedic management. Additionally, mechanism of injury, definitive management, time to surgery, length of stay, level of care at discharge, and demographic data were compared against similar patients who did not receive a pan-scan.
Results: Of the 109 patients who underwent a CT pan-scan, one (0.92%) had a change in orthopedic treatment .12 patients (11.01%) had changes to their non-orthopedic management, with only 2 requiring invasive intervention. Of these 12, 10 patients had a presenting history or physical exam that correlated with the CT pan-scan findings. In addition, 14 other patients had one or more consultations obtained based on pan-scan results that did not result in any change in management.
Conclusion: This study demonstrates whole body CT imaging provides little benefit in geriatric patients who sustain fragility fractures and should be utilized judiciously and in a targeted fashion instead of as a routine part of TD or ED protocol in this patient population.
Level of Evidence: Level III Retrospective Study.
