Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients?

Author:

Lepkowsky Eric1ORCID,Simcox Trevor2,Rogoff Hunter1,Barzideh Omid2,Islam Shahidul2

Affiliation:

1. Department of Orthopedic Surgery, Stony Brook University, Stony Brook, NY, USA

2. Department of Orthopedic Surgery, NYU Winthrop Hospital, Mineola, NY, USA

Abstract

Introduction:Computed tomography (CT) pan-scans have become increasingly commonplace as part of the initial diagnostic workup 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.Methods:A retrospective review was conducted of patients who sustained a fragility fracture at a level-1 trauma center over a 15-month period. Radiologist interpretations of any CT pan-scans were reviewed for acute findings, and charts were reviewed for resulting changes in orthopedic and nonorthopedic 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, 1 (0.92%) had a change in orthopedic treatment. Twelve (11.01%) patients had changes to their nonorthopedic management. 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.Discussion:This study found that only 1 of the included patients had a change in orthopedic management and 12 had a change in nonorthopedic management, despite over half of the study population being found to have additional findings. Furthermore, patients who underwent a pan-scan did not have expedited surgical intervention or earlier discharges compared to those who were not pan-scanned.  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 trauma surgery or emergency department protocol in this patient population.Level of Evidence:Level III Retrospective Study.

Publisher

SAGE Publications

Subject

Geriatrics and Gerontology,Rehabilitation,Orthopedics and Sports Medicine,Surgery

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