Computed Tomography Scan as First-Line Imaging in Patients Suspected of a Proximal Femoral Fracture Without Obvious Clinical Findings-A Cohort Study of 927 Patients.

OBJECTIVES

To investigate whether first-line CT imaging, as an alternative to standard radiography, reduces the time from admission to surgery in patients suspected of a proximal femoral fracture without classic clinical signs.

DESIGN

A retrospective cohort study.

SETTING

Single center Level 2 trauma center, Slagelse Hospital, Region Zealand, Denmark.

PATIENT SELECTION CRITERIA: Patients aged 65 years and above, admitted between June 1, 2018, and May 31, 2019, undergoing radiography and/or CT of the proximal femur AO/OTA 31 or pelvis AO/OTA 61 were included.

OUTCOME MEASURE AND COMPARISONS: The primary outcome was comparing time from admission to surgery, mortality, and fracture distribution between the 2 groups.

RESULTS

Nine hundred twenty-seven patients were included, 452 patients before and 475 after the new imaging guideline. After the implementation of this new imaging guideline, there was a significant decrease in time from arrival at the emergency department to surgery from 1229 to 1050 minutes ( P = 0.03). Patients time to surgery was 179 minutes faster than before, a savings of approximately 3 hours and the reduced time to surgery did not lead to a significant difference on the 30-day (before = 13.23, after = 18.03 days, P = 0.29) and 1-year (before = 106.3, after = 133.45 days, P = 0.21) mortality rate.

CONCLUSIONS

The new imaging guideline decreased the time from arrival at the emergency department to surgery.

LEVEL OF EVIDENCE: Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.