Introduction
Age is considered as a minor or major risk factor for traumatic intracranial lesions after a fall or any significant head injury. Falls in older adults often result from a combination of factors including environmental hazards, physical impairment, and underlying medical conditions. Early CT scanning is nowadays considered as an important tool to evaluate the severity of complexities related to falls or head injuries, and it can significantly reduce the ICU admission rate and decrease H-LOS[1]. The purpose of this research proposal is to evaluate the necessity of the CT trauma Series for elderly patients with falls. In this proposal, a brief discussion on the research topic will be carried out along with a discussion on expected outcomes and methods that have to be used to allocate data to identify the importance of CT Trauma in elderly people with falls.
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Research background
Falls are the major cause of injury in all ages. According to the World Health Organization, falls are one of the prime reasons for accidental or unintentional injury across the world[2]. A ground-level fall or GLF is a low-energy form of trauma that can occur at every age, but it is one of the most common causes and mechanisms of trauma for older people. Falls can cause serious injuries including fractures, and intracranial or spinal cord injuries in the elderly population in comparison to the young population[3]. In such a scenario, a CT scan or Computed Tomography is an important diagnostic method for use in the triage and treatment of trauma patients. However, several researchers raised concerns about the use of CT trauma series for older people, as it is related to the use of high radiation, high cost, and limited clinical benefits. Many researchers mentioned that while CT scans can detect occult injuries, many older patients are recommended to undergo unnecessary imagining which leads to an increase in health cost and patient burden without improving the outcome[4]. CT protocols in trauma patients also differ from one healthcare centre to another. More specifically, when some healthcare professionals prefer whole-body CT scans or WBCT for trauma patients, some of them focus on using CT scans on affected areas based on the type of trauma[5]. In this proposal, the focus will be given to carrying out a cohort retrospective study to evaluate the importance of the trauma CT series on elderly fall patients.
Research Aim and Objectives
This research proposal aims to evaluate the necessity and importance of CT trauma series for elderly patients after falls.
Considering the aim of this research proposal, the primary objective will be: to determine the necessity of CT trauma series for patients who have experienced falls.
The secondary objectives of this proposal are:
- To determine the incidence of clinically significant findings in CT trauma series in the targeted population.
- To determine the impact of CT trauma series for risk management related to falls among the targeted population and its outcome.
- To explore the alternative imagining strategies and their effectiveness in comparison to standard CT Trauma series to identify the risk related to falls among older patients.
Research question
The research questions for this proposed work will be:
Main Question:
How and to what extent CT trauma series can identify the significant injuries of elderly patients who experienced falls and can change patient management?
Sub-questions:
- Could selective or alternative imaging strategies like targeted CT scans and MRIs reduce the risk of radiation exposure and healthcare cost burden while maintaining the accuracy of the diagnostic process for older patients?
- What is the rate of unnecessary findings in CT trauma series among elderly fall patients?
Literature Review
Falls are considered as one of the leading causes of head trauma and several injuries and it represent a significant cause of morbidity and mortality in any population or any age group. According to research falls can cause accidental or unintentional injuries, and in the case of the elderly population, falls can be considered as the common mechanism of trauma among older patients[6]. In a study about fall-related injuries, it was evident that head, neck, pelvic, and any extremity injuries are more frequent and severe in GLF or ground-level fall patients older than 65 years[7]. Falls can also increase the mortality rate by 10 times among patients older than 65 years in comparison to those who are younger than 65 years. Computerised tomography or CT scan is a non-invasive medical imaging process that uses radiation or X-rays to create a detailed image of inside parts of the body. A computed tomography trauma series also known as whole-body CT or trauma CT is a comprehensive imaging process used to quickly assess the patient who experienced multiple injuries due to falls and trauma[8]. According to [9]a CT scan in trauma series is considered to be a valuable tool to detect intracranial haemorrhages, which are most common in case of falls for older people and can cause mortality among the targeted population. On the other hand, CT imaging can assist in quickly triaging patients, and guide them to the treatment decision, including surgical intervention or intensive monitoring, which can further improve the patient’s health and outcomes by reducing hospital stays[10]. However, the major concern related to the use of CT trauma series due to the association of high levels of radiation exposure, which can increase the risk of malignancy and other health risks over time, specifically for frail older patients[11]. However, it can be stated that CT trauma series can offer enormous advantages to manage the risks for older patients who experienced falls by providing detailed images of critical areas including the head, and chest, and can allow detection of occult injuries that might be missed in general clinical examination.
Research Methodology
To evaluate the necessity and importance of using CT trauma series for older patients who experienced falls, a retrospective cohort study has to be used to gather relevant data and information. The justification of using a retrospective cohort study for this proposed work can be linked to its effectiveness in evaluating the necessity and importance of CT trauma series in elderly fall patients because this method can allow the research to analyse the existing patient data and access outcomes, imaging use, and injury detection rate[12]. Retrospective data can enable to identification of the trends of using CT trauma series in detecting the risk related to falls among patients, which can provide insight into the significance and disadvantages of this method.
For carrying out the retrospective study, elderly patients aged 65 years and above and those who were admitted to the emergency department with falls and underwent CT trauma series between January 2020 to December 2023 have been selected as the sample. For collecting the data, patient electronic records, including demographics, clinical data, CT scan findings and subsequent information about the patient should be taken into consideration. To measure the necessity of using a CT trauma series for an older patient with falls, a comparison between the clinically significant injuries (fractures and internal bleeding) and their impact will be carried out. The outcome of this comparison can provide the effectiveness of CT trauma series to detect and manage fall-related risks, and health complications among older patients.
For data analysis, focus will be given to measuring descriptive statistics, comparative analysis and cost analysis process. The evaluation of statistical data collected from existing studies can provide an idea about the prevalence rate and significance of using CT scans to detect injuries. Comparative analysis between patient management and patient outcomes from existing articles can provide a significant overview of the effectiveness of the method in clinical practice, whereas cost analysis can help to evaluate the cost-effectiveness of CT trauma series in comparison to other alternative imaging strategies.
Ethical Consideration
This study will include patients’ electronic data for carrying out a retrospective study on the research topic. Therefore, informed consent will be asked from the hospitals to use those data. According to the Data Protection Act, 2010, it would be ensured that; the data are anonymised and confidentiality has to be maintained while assessing patient information[13].
Expected Outcome
From the cohort retrospective studies, this research might reveal the incidental findings about the necessity of using CT trauma series to treat older patients who are admitted to the hospital due to injuries caused by falls. Considering several existing research articles, it can be expected that this proposal will state that the CT trauma series is an effective tool to be used for the early detection of neurological deterioration and mortality due to falls among patients[14]. From the retrospective study, it can also be evaluated that a targeted CT scan is more effective than full-body imaging, as it can reduce the radiation exposure, and cost burden. Targeted CT scans can also provide specific information about the severity of injuries caused by falls which increase the effectiveness of medical intervention and patient outcomes. Based on the outcome, this study will likely recommend a more selective imaging protocol, by aiming to reduce the exposure rate of radiation, and healthcare costs.
Significance of the topic
Research on the topic ‘evaluation of the necessity of CT Trauma Series in elderly patients with falls’ can address the potential overuse of CT Trauma Series in emergency departments of hospitals to provide medical support to patients experiencing injuries due to falls. This study can provide scope to identify the disadvantages related to the use of CT scan techniques for older people and can find ways to implement improved methods to increase patient outcomes.
Timeline
|
Activities |
Expected time |
|
Study design, review of literature, set up research objectives |
2 months |
|
Collection of data from emergency departments of different hospitals, and patients' electronic data records |
6 months |
|
Analysis of data |
3 months |
|
Report writing and final submission |
2 months |
Budget
|
Category |
Estimated cost |
|
Research assistants |
$200 |
|
Data analysts |
$100 |
|
Medical records access |
$100 |
|
Miscellaneous |
$100 |
|
IRB fees |
$100 |
|
Publication costs |
$100 |
|
Total estimated cost |
$700 |
Bibliography
1.Selcuk Parlak, Esra Çıvgın, Muhammed Said Beşler, Seçil Gündoğdu. Ground level falls: computed tomography findings and clinical outcomes by age groups. Turkish Journal of Trauma and Emergency Surgery [Internet]. 2023 Jan 1 [cited 2024 Sep 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315935/
10.Sakkas A, Weiß C, Wilde F, Ebeling M, Scheurer M, Thiele OC, et al. Justification of Indication for Cranial CT Imaging after Mild Traumatic Brain Injury According to the Current National Guidelines. Diagnostics. 2023 May 23;13(11):1826–6.
11.Cushing C, Holmes J, Tyler K. Cervical Spine Injuries in Older Patients with Falls Found on Magnetic Resonance Imaging After Computed Tomography. Western Journal of Emergency Medicine. 2021 Sep 2;22(5):1190–5.
12.Tucker K, Branson J, Dilleen M, Hollis S, Loughlin P, Nixon MJ, et al. Protecting patient privacy when sharing patient-level data from clinical trials. BMC Medical Research Methodology [Internet]. 2016 Jul [cited 2024 Sep 14];16(S1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943495/
2.Coffeng SM, Foks KA, van den Brand CL, Jellema K, Dippel DWJ, Jacobs B, et al. Evaluation of Clinical Characteristics and CT Decision Rules in Elderly Patients with Minor Head Injury: A Prospective Multicenter Cohort Study. Journal of Clinical Medicine [Internet]. 2023 Jan 1 [cited 2024 Sep 14];12(3):982. Available from: https://www.mdpi.com/2077-0383/12/3/982
3.van den Hout WJ, van der Wilden GM, Boot F, Idenburg FJ, Rhemrev SJ, Hoencamp R. Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome? European Journal of Trauma and Emergency Surgery [Internet]. 2018 Aug 1 [cited 2024 Sep 14];44(4):607–14. Available from: https://link.springer.com/article/10.1007%2Fs00068-017-0831-5
4.World Health Organization. Falls [Internet]. www.who.int. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/falls#:~:text=Key%20facts
5.Mohamed H, Teoh K. Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center. Chinese Journal of Traumatology. 2021 Apr;
6.Attar M, Alsinnari YM, Alqarni MS, Bukhari ZM, Alzahrani A, Abukhodair AW, et al. Common Types of Falls in the Elderly Population, Their Associated Risk Factors and Prevention in a Tertiary Care Center. Cureus [Internet]. 2021 May 6 [cited 2024 Sep 14];13(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184103/
7.Selcuk Parlak, Esra Çıvgın, Muhammed Said Beşler, Seçil Gündoğdu. Ground level falls: computed tomography findings and clinical outcomes by age groups. Turkish Journal of Trauma and Emergency Surgery [Internet]. 2023 Jan 1; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315935/
8.Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: Review of the current literature. Turkish Journal of Emergency Medicine. 2018 Dec;18(4):142–7.
9.Fadzil F, Mei AKC, Mohd Khairy A, Kumar R, Mohd Azli AN. Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression. International Journal of Environmental Research and Public Health [Internet]. 2022 Nov 2 [cited 2024 Sep 14];19(21):14311. Available from: https://pubmed.ncbi.nlm.nih.gov/36361190/
[1] van den Hout WJ, van der Wilden GM, Boot F, Idenburg FJ, Rhemrev SJ, Hoencamp R. Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome? European Journal of Trauma and Emergency Surgery [Internet]. 2018 Aug 1 [cited 2024 Sep 14];44(4):607–14. Available from: https://link.springer.com/article/10.1007%2Fs00068-017-0831-5
[2] World Health Organization. Falls [Internet]. www.who.int. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/falls#:~:text=Key%20facts
[3] Selcuk Parlak, Esra Çıvgın, Muhammed Said Beşler, Seçil Gündoğdu. Ground level falls: computed tomography findings and clinical outcomes by age groups. Turkish Journal of Trauma and Emergency Surgery [Internet]. 2023 Jan 1 [cited 2024 Sep 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315935/
[4] Mohamed H, Teoh K. Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center. Chinese Journal of Traumatology. 2021 Apr;
[5]Coffeng SM, Foks KA, van den Brand CL, Jellema K, Dippel DWJ, Jacobs B, et al. Evaluation of Clinical Characteristics and CT Decision Rules in Elderly Patients with Minor Head Injury: A Prospective Multicenter Cohort Study. Journal of Clinical Medicine [Internet]. 2023 Jan 1 [cited 2024 Sep 14];12(3):982. Available from: https://www.mdpi.com/2077-0383/12/3/982
[6] Attar M, Alsinnari YM, Alqarni MS, Bukhari ZM, Alzahrani A, Abukhodair AW, et al. Common Types of Falls in the Elderly Population, Their Associated Risk Factors and Prevention in a Tertiary Care Center. Cureus [Internet]. 2021 May 6 [cited 2024 Sep 14];13(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184103/
[7] Selcuk Parlak, Esra Çıvgın, Muhammed Said Beşler, Seçil Gündoğdu. Ground level falls: computed tomography findings and clinical outcomes by age groups. Turkish Journal of Trauma and Emergency Surgery [Internet]. 2023 Jan 1 [cited 2024 Sep 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315935/
[8] Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: Review of the current literature. Turkish Journal of Emergency Medicine. 2018 Dec;18(4):142–7.
[9] Fadzil F, Mei AKC, Mohd Khairy A, Kumar R, Mohd Azli AN. Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression. International Journal of Environmental Research and Public Health [Internet]. 2022 Nov 2 [cited 2024 Sep 14];19(21):14311. Available from: https://pubmed.ncbi.nlm.nih.gov/36361190/
[10] Sakkas A, Weiß C, Wilde F, Ebeling M, Scheurer M, Thiele OC, et al. Justification of Indication for Cranial CT Imaging after Mild Traumatic Brain Injury According to the Current National Guidelines. Diagnostics. 2023 May 23;13(11):1826–6.
[11] Mohamed H, Teoh K. Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center. Chinese Journal of Traumatology. 2021 Apr;
[12] Cushing C, Holmes J, Tyler K. Cervical Spine Injuries in Older Patients with Falls Found on Magnetic Resonance Imaging After Computed Tomography. Western Journal of Emergency Medicine. 2021 Sep 2;22(5):1190–5.
[13] Tucker K, Branson J, Dilleen M, Hollis S, Loughlin P, Nixon MJ, et al. Protecting patient privacy when sharing patient-level data from clinical trials. BMC Medical Research Methodology [Internet]. 2016 Jul [cited 2024 Sep 14];16(S1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943495/
[14] Selcuk Parlak, Esra Çıvgın, Muhammed Said Beşler, Seçil Gündoğdu. Ground level falls: computed tomography findings and clinical outcomes by age groups. Turkish Journal of Trauma and Emergency Surgery [Internet]. 2023 Jan 1; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315935/
