Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications.

Sandra Niedermeier,Wolfgang Böcker,Christoph Trumm,Marco Armbruster,Christian H Nickel,Roland Bingisser,Alina Lampart,Christian Kammerlander,Robert Stahl,Vera Pedersen,Rebecca Wania

doi:10.3390/diagnostics12020354

Abstract

Background: Computed tomography (CT) is commonly used in trauma care, with increasing implementation during the emergency work-up of elderly patients with low-energy falls (LEF). The prevalence of incidental findings (IFs) resulting from CT imaging and requiring down-stream actions in this patient cohort is unknown. We have investigated the prevalence and urgency of IFs from emergency CT examinations in these patients. Methods: A total of 2871 patients with LEF and emergency CT examinations were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of IFs; the secondary endpoint was their urgency. Results: The median age was 82 years (64.2% were women). IFs were identified in 73.9% of patients, with an average of 1.6 IFs per patient. Of all IFs, 16.4% were classified as urgent or relevant, predominantly in the abdomen, chest and neck. Increasing age was associated with the prevalence of an IF (odds ratio: 1.053, 95% confidence interval: 1.042–1.064). Significantly more IFs were found in female patients (75.2% vs. 71.5%). Conclusion: IFs resulting from CT examinations of the elderly are frequent, but in more than 8 out of 10, they are harmless or currently asymptomatic. For the benefit of an accurate diagnosis of traumatic lesions, concerns about IFs with respect to disease burden, further work-up and resource utilisation might be disregarded.

Highlights

IntroductionIn patients suffering from high-energy trauma, whole-body Computed tomography (CT) (WBCT) scans are increasingly used and recommended by guidelines due to their real-time detection of acute traumatic injuries (ATI) with high specificity and sensitivity and their widespread availability [1,2,3,4]
Computed tomography (CT) is a commonly used imaging modality in trauma care
The prevalence of incidental findings (IFs) in different trauma patient populations varies from 30.4% to 75.3% [5,6,8,9,10,12,13,14,15,16,18,19,20,21], with more findings detected by means of whole-body CT (WBCT) than by selective CT scans [10]

Summary

Introduction

In patients suffering from high-energy trauma, whole-body CT (WBCT) scans are increasingly used and recommended by guidelines due to their real-time detection of acute traumatic injuries (ATI) with high specificity and sensitivity and their widespread availability [1,2,3,4]. Besides their associated radiation exposure [1,2], WBCT scans are likely to reveal incidental findings (IF) unrelated to the preceding trauma [5,6,7,8,9,10,11,12,13,14,15,16,17]. For the benefit of an accurate diagnosis of traumatic lesions, concerns about IFs with respect to disease burden, further work-up and resource utilisation might be disregarded

Objectives

Methods

Results

Discussion

Conclusion