CT scan evaluation of injuries in patients over 60 years old following a fall from standing height

To evaluate the range and severity of acute injuries sustained by patients over 60 years old presenting to a tertiary centre emergency department following a fall from standing height on computed tomography (CT) and the appropriate imaging protocol to utilise in this cohort.

We conducted a retrospective review of all CT thorax requests for patients over 60 years old following a fall from standing height between 2019 and 2020. CT requests and reports were extracted from the radiology information system and appropriate scans identified for inclusion. Clinical data was extracted from electronic patient records.

349 patients over 60 years old underwent a CT scan following a fall from standing height. Of these, 204 underwent a non-contrast CT chest and 145 underwent contrast enhanced CT thorax abdomen pelvis. 178 (51%) of patients had an acute finding on thoracic CT; 170 patients had 1 or more rib fractures, 16 had radiological flail segments, 30 patients had a pneumothorax and 44 had a haemothorax. 36 patients sustained an acute fracture other than rib fracture. 45 patients with rib fractures on CT also underwent concurrent CXR; however, only 15 of these patients had rib fractures visible on CXR. Out of the 145 patients who underwent abdominal-pelvic CT, 23 (16%) patients had an acute traumatic finding.

Patients aged over 60 are at high risk of sustaining thoracic injury following a fall from standing height. Acute findings were identified in over half of elderly patients who underwent thoracic CT due to clinical suspicion of thoracic injury. Rib fractures were the most common finding, and were often missed on concurrent CXR. Comparatively, acute abdominal injury was rare in this cohort. These results emphasize the importance of CT thorax imaging in accurately diagnosing fall-related injuries in older adults.