Clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures

ObjectiveTo define the role of head computed tomography (CT) scans in the geriatric population with isolated low-energy femur fractures and describe the pertinent clinical variables which are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed.DesignRetrospective review.SettingLevel I trauma centre.PatientsEleven hundred ninety-two (1192) patients sustaining a femur fracture following a low-energy fall.Main outcome measurementPertinent clinical variables that were associated with CTs that yielded positive findings.ResultsTwo hundred fifty patients (21%) underwent a head CT scan as part of their evaluation. Of these patients, 83% suffered proximal femur fractures, 11% shaft fractures and 6% distal fractures. The majority of the patients were evaluated by the emergency department (ED) with only 18% (44/250) being evaluated by the trauma team. Average patient age was 83 years (range 65–99 years). One hundred seventy-three patients (69%) were on some form of antiplatelet medication or anticoagulation. Of the 250 patients who underwent head CT scan, 16 (6%) patients had acute findings (haemorrhage – 15, infarct – 1), and none of the patients required neurosurgical intervention.ConclusionNone of the patients with a traumatic injury required a neurosurgical invention after sustaining a low energy fall (0/1192). Head CT scans should have a limited role in the work-up of this patient population and should be reserved for patients with a history and physical findings that support head trauma.Level of evidence: Prognostic level III. See instructions for authors for a complete description of levels of evidence.