{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:22:12Z","timestamp":1793802132691,"version":"4.6.1"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016015","name":"University Hospital Basel","doi-asserted-by":"crossref","award":["VW Pool Pedersen"],"award-info":[{"award-number":["VW Pool Pedersen"]}],"id":[{"id":"10.13039\/100016015","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2020,10,4]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 (\u226565 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2020-000560","type":"journal-article","created":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T03:22:18Z","timestamp":1604460138000},"page":"e000560","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0542-5684","authenticated-orcid":false,"given":"Vera","family":"Pedersen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Lampart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Bingisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Hans","family":"Nickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"2024110101555526000_5.1.e000560.1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2017.5.33615"},{"key":"2024110101555526000_5.1.e000560.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2006.10.001"},{"key":"2024110101555526000_5.1.e000560.3","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.cger.2018.04.002","article-title":"Older adult falls in emergency Medicine-A sentinel event","volume":"34","author":"Carpenter","year":"2018","journal-title":"Clin Geriatr Med"},{"key":"2024110101555526000_5.1.e000560.4","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1016\/j.injury.2016.06.019","article-title":"The older they are the harder they fall: injury patterns and outcomes by age after ground level falls","volume":"47","author":"Bhattacharya","year":"2016","journal-title":"Injury"},{"key":"2024110101555526000_5.1.e000560.5","unstructured":"World Health Organization (WHO) . Falls. 2018. www.who.int\/news-room\/fact-sheets\/detail\/falls (27 Nov 2018)."},{"key":"2024110101555526000_5.1.e000560.6","unstructured":"Trauma Audit and Research Network (TARN) . Major Trauma in Older People. 2017. https:\/\/www.tarn.ac.uk\/content\/downloads\/3793\/Major%20Trauma%20in%20Older%20People%202017.pdf (7 Sep 2018)."},{"key":"2024110101555526000_5.1.e000560.7","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/1742-6723.12785","article-title":"Major trauma in the older patient: evolving trauma care beyond management of bumps and bruises","volume":"29","author":"Carpenter","year":"2017","journal-title":"Emerg Med Australas"},{"key":"2024110101555526000_5.1.e000560.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/164632","article-title":"Ground-Level geriatric falls: a not-so-minor mechanism of injury","volume":"2014","author":"Parker","year":"2014","journal-title":"Case Rep Orthop"},{"key":"2024110101555526000_5.1.e000560.9","doi-asserted-by":"crossref","first-page":"342.e1","DOI":"10.1016\/j.ajem.2017.10.062","article-title":"Nondisplaced pubic ramus fracture associated with exsanguination and death","volume":"36","author":"Rich","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2024110101555526000_5.1.e000560.10","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/TA.0b013e31822ad41f","article-title":"Hemorrhage after low-energy pelvic trauma","volume":"72","author":"Krappinger","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2024110101555526000_5.1.e000560.11","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.12.2008.1400"},{"key":"2024110101555526000_5.1.e000560.12","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1007\/s00296-016-3524-1","article-title":"Spinal fractures in patients with ankylosing spondylitis","volume":"36","author":"Leone","year":"2016","journal-title":"Rheumatol Int"},{"key":"2024110101555526000_5.1.e000560.13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/MEJ.0000000000000452","article-title":"Influences on emergency department length of stay for older people","volume":"25","author":"Street","year":"2018","journal-title":"Eur J Emerg Med"},{"key":"2024110101555526000_5.1.e000560.14","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"2024110101555526000_5.1.e000560.15","doi-asserted-by":"crossref","unstructured":"O\u2019Connor D , Green S , Higgins JPT . Defining the review question and developing criteria for including studies. In: Higgins JPT , Green S , Cochrane Handbook for systematic reviews of interventions version 5.0.0: The Cochrane Collaboration, 2008.","DOI":"10.1002\/9780470712184.ch5"},{"key":"2024110101555526000_5.1.e000560.16","unstructured":"Wells GA , Shea B , O\"Connell D . The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2009. http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"2024110101555526000_5.1.e000560.17","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-3-25"},{"key":"2024110101555526000_5.1.e000560.18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-20"},{"key":"2024110101555526000_5.1.e000560.19","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/TA.0000000000002208","article-title":"Chest computed tomography imaging utility for radiographically occult rib fractures in elderly fall-injured patients","volume":"86","author":"Singleton","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2024110101555526000_5.1.e000560.20","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3390\/jcm9010097","article-title":"Prevalence of fractures and diagnostic accuracy of emergency X-ray in older adults sustaining a low-energy fall: a retrospective study","volume":"9","author":"Lampart","year":"2019","journal-title":"J Clin Med"},{"key":"2024110101555526000_5.1.e000560.21","first-page":"477","article-title":"[Influence of routine CT examination on fracture classification and therapy for pelvic ring fractures in patients aged over 65 years old]","volume":"150","author":"B\u00f6hme","year":"2012","journal-title":"Z Orthop Unfall"},{"key":"2024110101555526000_5.1.e000560.22","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10140-011-1009-9","article-title":"High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma","volume":"19","author":"Dunker","year":"2012","journal-title":"Emerg Radiol"},{"key":"2024110101555526000_5.1.e000560.23","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1308\/003588414X13824511650533","article-title":"The use of computed tomography in identifying radiologically occult hip fractures in the elderly","volume":"96","author":"Heikal","year":"2014","journal-title":"Ann R Coll Surg Engl"},{"key":"2024110101555526000_5.1.e000560.24","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/BOT.0000000000000761","article-title":"Advanced imaging lacks clinical utility in treating geriatric pelvic ring injuries caused by low-energy trauma","volume":"31","author":"Natoli","year":"2017","journal-title":"J Orthop Trauma"},{"key":"2024110101555526000_5.1.e000560.25","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.injury.2016.01.027","article-title":"Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma","volume":"47","author":"Schicho","year":"2016","journal-title":"Injury"},{"key":"2024110101555526000_5.1.e000560.26","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20150250","article-title":"The validity of investigating occult hip fractures using multidetector CT","volume":"89","author":"Thomas","year":"2016","journal-title":"Br J Radiol"},{"key":"2024110101555526000_5.1.e000560.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.10.050"},{"key":"2024110101555526000_5.1.e000560.28","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.ejrad.2013.01.016","article-title":"Fractures of the thoracic spine in patients with minor trauma: comparison of diagnostic accuracy and dose of biplane radiography and MDCT","volume":"82","author":"Karul","year":"2013","journal-title":"Eur J Radiol"},{"key":"2024110101555526000_5.1.e000560.29","first-page":"179","article-title":"Use of CT vs. MRI for diagnosis of hip or pelvic fractures in elderly patients after low energy trauma","volume":"39","author":"Eggenberger","year":"2019","journal-title":"Iowa Orthop J"},{"key":"2024110101555526000_5.1.e000560.30","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/jgs.14737","article-title":"Guarding against Overtesting, overdiagnosis, and overtreatment of older adults: thinking beyond imaging and injuries to weigh harms and benefits","volume":"65","author":"Hoffman","year":"2017","journal-title":"J Am Geriatr Soc"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2020-000560","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T04:57:11Z","timestamp":1730437031000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2020-000560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,11,3]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/tsaco-2020-000560"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2020-000560","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}