Silver trauma: is whole body CT warranted in low impact trauma

Trauma in the elderly is associated with high mortality. Elderly people who have suffered low impact trauma, such as fall from standing (FFS) are believed still to be at high risk of injury. Whole body trauma CT (WBCT) is increasingly used to image such people, to prevent missing injuries which are not detected clinically. This study aims to assess the utility of WBCT in assessing elderly people who have suffered FFS.

Over a 2-year period in a single health board, data were collected retrospectively for all patients that underwent WBCT. Data were collected on the mechanism, pattern of injury, and outcomes including 30-day mortality using clinical records. Comparison was made between pre-CT clinical suspicion and injury found on WBCT to identify discrepancies.

In total, 460 patients were included in this study. Compared with FFS, fall from more than standing was associated with higher adjusted odds of having an injury out with zone of clinical suspicion (Adjusted Odds Ratio (AOR) 2.80, 95% CI 1.23-7.28; P = .021). There was no significant difference in 30-day mortality between patients who had an injury on WBCT and those without.

FFS is associated with a reduced risk of injury out with areas of clinical concern when compared with fall from greater than standing. As such, a targeted approach to CT scanning in these patients could be considered.

This study challenges the current prevailing dogma for the requirement of WBCT in elderly people who suffer FFS, providing evidence that such people have a low risk of injuries out with areas of clinical suspicion.