Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls

Brianna L Collie; Luciana Tito Bustillos; Shane L Collins; Nicole B Lyons; Walter A Ramsey; Christopher F O'Neil; Joyce I Kaufman; Jonathan P Meizoso; Kenneth G Proctor; Nicholas Namias

doi:10.1016/j.jss.2024.12.016

Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls

J Surg Res. 2025 Jan 9:306:182-187. doi: 10.1016/j.jss.2024.12.016. Online ahead of print.

Affiliations

¹ Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida. Electronic address: blc110@med.miami.edu.
² Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.

PMID: 39793304
DOI: 10.1016/j.jss.2024.12.016

Abstract

Introduction: Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.

Materials and methods: Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.

Results: In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.

Conclusions: In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.

Keywords: Cervical spine CT; Fall; Geriatric; Head CT.