The Journal of surgical research · 2025
Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Collie Brianna L, Bustillos Luciana Tito, Collins Shane L, Lyons Nicole B, Ramsey Walter A, O'Neil Christopher F, Kaufman Joyce I, Meizoso Jonathan P, Proctor Kenneth G, Namias Nicholas
Аннотация
INTRODUCTION: Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.
MATERIALS AND METHODS: Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.
RESULTS: In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.
CONCLUSIONS: In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.
MATERIALS AND METHODS: Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.
RESULTS: In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.
CONCLUSIONS: In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.