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Bone Mineral Density Measurements as Predictors of Injury Patterns in Elderly Trauma Patients
*Ian Schlieder, *Michael Kelleher, Bishwajit Bhattacharya, Adrian Maung, Kimberly Davis, Kevin Schuster
Yale University, New Haven, CT
Objective: Bone mineral density (BMD), assessed with standard CT, will predict fractures remote from the cervical spine and may assist with decisions regarding additional imaging.
Design: Trauma registry review (January 2011 – December 2014). Trauma patients aged 65 or greater with a fall mechanism who underwent CT scanning of the head, neck, abdomen and pelvis were included.
Setting: Urban, academic level 1 trauma center.
Patients: 378 patients, mean age of 82 years (SD 8.7), 171 males. Mean Injury Severity Score was 10.3 (SD 6.9). Mean LOS was 6.2 days and ICU admission was required in 132 patients (35%).
Main Outcome Measures: Houndsfield units were recorded at the C7 (C7HU) and L3 (L3HU) levels based off of 1.25mm axial images. BMDs were compared with fracture incidence at remote sites. Morbidity, mortality, length of stay were recorded.
Results: Low C7HU were associated with humerus, hip, pelvic and lumbar fractures while low L3HU were associated with hip and thoracic fractures (table).There were no significant relationships between C7HU or L3HU and outcomes including mortality. Cervical spine fracture was not associated with other injuries including other spine fractures, but was negatively correlated with hip fracture. In multivariable analysis a low C7HU (p=0.030) but not C-spine fracture (p=0.0599) was associated with lumbar spine fracture. Above 300 C7HU or 200 L3HU only 5 (1.3%) patients had remote fractures.
Conclusions: In elderly trauma patients, with even minor injury mechanisms, low C7HU not the presence of c-spine fracture should prompt careful consideration for further spine imaging, high values are reassuring.
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