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Systematic review
Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence
  1. Vera Pedersen1,
  2. Alina Lampart2,
  3. Roland Bingisser3,
  4. Christian Hans Nickel3
  1. 1Department for General, Trauma and Reconstructive Surgery, University Hospital Munich, Munich, Germany
  2. 2Department of Internal Medicine, Upper Valais Hospital Center Visp Location, Visp, Valais, Switzerland
  3. 3Emergency Department, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Vera Pedersen; vera.pedersen{at}med.uni-muenchen.de

Abstract

Background Older individuals sustaining low-energy falls (LEF) and presenting to the emergency department (ED) demand straightforward diagnostic measures for injury detection. Plain radiography (XR) series for diagnosis of fall-related injuries are standard of care, but frequently subsequent CT examination is required for diagnostic assurance. A systematic database search of diagnostic accuracy of XR for detection of fractures in older LEF patients was performed.

Methods We searched PubMed, Embase, Cochrane Library, WHO International Clinical Trial Platform, and Clinical trials.gov databases from inception to January 2020 for studies including older patients (≥65 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting.

Results From 8944 references screened, 11 studies met the criteria for inclusion. Performance of XR for detection of fractures of the pelvic ring and hip was analyzed in nine studies, two studies investigated XR performance to detect rib fractures, and two studies compared diagnostic accuracy of thoracolumbar spine XR. Sensitivity estimates ranged from 10% to 58% and specificity estimates from 55% to 100%. Clinical and statistical heterogeneity was significant among included studies, with an overall considerable risk of bias.

Discussion High-quality evidence on accurate imaging strategies in older patients with LEF is lacking to date. XR is missing a reasonable amount of fractures of the pelvic ring, rib cage, and thoracic and lumbar spine. However, the utility of first-line CT imaging and the benefit of diagnosing every fracture is unknown, demanding high-quality prospective trials considering patient-oriented outcome as well.

  • accidental falls
  • emergency department
  • geriatrics
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000560

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    Footnotes

    • Contributors VP, CHN and RB conceived and designed the study. VP, CHN and RB supervised the data collection. VP and AL selected abstracts, extracted data and evaluated study quality. VP and AL drafted the article and all authors contributed substantially towards its revision. VP takes responsibility for the article as a whole.

    • Funding VP and RB obtained research funding from the University Hospital Basel.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.