Patterns and implications of missed injuries on computed tomography imaging in older blunt trauma patients

Older adults sustain disproportionately morbid injuries from low energy mechanisms, yet guidance around computed tomography imaging is lacking for this demographic. We hypothesize that current imaging practices may lead to potentially missed injuries, increasing morbidity and mortality.

A secondary analysis of a prospective multicenter study (11/2020-12/2021) of older blunt trauma patients was performed. Suboptimal imaging was defined as a mismatch between final injury diagnosis and initial computed tomography imaging. We compared optimally vs not optimally imaged patients to determine factors associated with suboptimal imaging and examined mortality, hospital length of stay, and critical care use with a multivariable logistic regression.

Among 5,496 patients from 18 trauma centers (median age 79), 5,023 (91.4%) were optimally imaged, and 473 (8.6%) were suboptimally imaged initially. Falls (75.1%) were the predominant injury mechanism. Computed tomography imaging was performed in 95% of cases. Most potentially missed injuries were in the thoracic and lumbar spine. Suboptimally imaged patients had higher mortality and longer median hospital stays. Patients imaged prior to transfer (odds ratio 1.39, 95% confidence interval 1.04-1.87, P = .027) or not triggering full or limited trauma activations (odds ratio 1.64, 95% confidence interval 1.09-2.45, P = .017) were more likely to have missed injuries.

More than 1 in 12 older blunt trauma patients received suboptimal computed tomography imaging initially. Our findings suggest that clinicians should maintain heightened awareness when evaluating older trauma patients as consults, those transferred from other facilities, or those facing language barriers, as these factors were associated with suboptimal imaging practices.