PT  - JOURNAL ARTICLE
AU  - Vera Pedersen
AU  - Alina Lampart
AU  - Roland Bingisser
AU  - Christian Hans Nickel
TI  - Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence
AID  - 10.1136/tsaco-2020-000560
DP  - 2020 Nov 01
TA  - Trauma Surgery & Acute Care Open
PG  - e000560
VI  - 5
IP  - 1
4099  - http://tsaco.bmj.com/content/5/1/e000560.short
4100  - http://tsaco.bmj.com/content/5/1/e000560.full
SO  - Trauma Surg Acute Care Open2020 Nov 01; 5
AB  - 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.