Keywords:
Bones, Trauma, Spleen, Conventional radiography, CT, Outcomes analysis, Health policy and practice, Audit and standards, Quality assurance, Geriatrics
Authors:
C. McDonnell1, S. Forman2; 1Co Dublin/IE, 2Dublin/IE
DOI:
10.1594/ecr2018/C-2035
Results
In the 5-month period reviewed in this audit,
19 falls occurred.
5 of the 19 falls required radiological work-up according to the conclusion of the medical review.
Imaging carried out included plain film radiographs (wrist,
elbow,
lumbar and thoracic spine,
pelvis - Fig. 1,
Fig. 2),
and CT (brain and pelvis -Fig. 3,
Fig. 4).
4 out of the 5 patients imaged had an obvious injury on review.
The fifth had fallen out-of-hours,
and did not appear to have any injuries at the time of review.
This was documented in the patient's notes.
Imaging was carried out 2 days later as the patient has subsequently developed symptoms and on review demonstrated point tenderness at the bony prominences of the wrist.
2 of the 5 patients imaged required transfer to a tertiary centre for imaging.
Transfer was required as CT imaging was indicated as per the medical review,
which was not available in the rehabilitation unit.
Pathology secondary to the fall was identified on imaging in 1 of the 5 patients - a left iliopsoas haematoma seen on CT pelvis (Fig. 3).
The patient complained of severe hip and groin pain following the fall; this patient was not on anticoagulation.
Positive findings not related to the fall was noted on a CT brain carried out on a patient on anticoagulation who had sustained a head injury.
On review of the patient,
it was noted that she had an occipital haematoma.
The CT showed no acute intracranial abnormality but there were age-related cortical atrophic changes,
an old right lacunar infarct,
and features consistent with small vessel ischaemia noted (Fig. 4).
Of note,
two-thirds of all falls not worked up radiologically occurred out-of-hours.
Significantly,
all patients who sustained falls had at least 2 risk factors for falls.