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Development of Imaging Criteria for Geriatric Blunt Trauma Patients

  • Sami K. Kishawi
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Victoria J. Adomshick
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
    Search for articles by this author
  • Penelope N. Halkiadakis
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Keira Wilson
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Northeast Ohio Medical University, Rootstown, Ohio
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  • Jordan C. Petitt
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Laura R. Brown
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Jeffrey A. Claridge
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Vanessa P. Ho
    Correspondence
    Corresponding author. MetroHealth Medical Center, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, 2500 MetroHealth Drive, Cleveland, OH 44109. Tel.: +1 216 778 4979
    Affiliations
    Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio

    Case Western Reserve University School of Medicine, Cleveland, Ohio

    Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
    Search for articles by this author
Published:December 07, 2022DOI:https://doi.org/10.1016/j.jss.2022.10.037

      Abstract

      Introduction

      Current decision tools to guide trauma computed tomography (CT) imaging were not validated for use in older patients. We hypothesized that specific clinical variables would be predictive of injury and could be used to guide imaging in this population to minimize risk of missed injury.

      Methods

      Blunt trauma patients aged 65 y and more admitted to a Level 1 trauma center intensive care unit from January 2018 to November 2020 were reviewed for histories, physical examination findings, and demographic information known at the time of presentation. Injuries were defined using the patient's final abbreviated injury score codes, obtained from the trauma registry. Abbreviated injury score codes were categorized by corresponding CT body region: Head, Face, Chest, C-Spine, Abdomen/Pelvis, or T/L-Spine. Variable groupings strongly predictive of injury were tested to identify models with high sensitivity and a negative predictive value.

      Results

      We included 608 patients. Median age was 77 y (interquartile range, 70-84.5) and 55% were male. Ground-level fall was the most common injury mechanism. The most commonly injured CT body regions were Head (52%) and Chest (42%). Variable groupings predictive of injury were identified in all body regions. We identified models with 97.8% sensitivity for Head and 98.8% for Face injuries. Sensitivities more than 90% were reached for all except C-Spine and Abdomen/Pelvis.

      Conclusions

      Decision aids to guide imaging for older trauma patients are needed to improve consistency and quality of care. We have identified groupings of clinical variables that are predictive of injury to guide CT imaging after geriatric blunt trauma. Further study is needed to refine and validate these models.

      Keywords

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