Emergency ultrasound of geriatric patient with minor head trauma in emergency department

Ultrasonography (US) has become an important application in the evaluation of bedside patients in the emergency department since the early 1990s. Currently, minor head injury emergency department admissions in the geriatric population are increasing. The aim of this study was to compare Emergency point-of-care ultrasonography (PoCUS) and computed tomography (CT) for possible skull bone fractures in patients aged 65 years and older. This prospective single-center study included random cases aged 65 years and older, admitted with head trauma from ground fall between August 01, 2022, and April 30, 2023, in Başkent University Emergency Medicine (EM) Department, Ankara. Inclusion criteria are local finding of trauma, Glasgow Coma Scale (GCS) score of 14≥, and exclusion criteria are high-energy head trauma, neurological findings, brain parenchyma pathology on tomography, hemodynamically unstable, open fracture, active bleeding, stroke, or history of brain operation. Philips® HDI 500 ultrasound device and L12-5 50 mm probe were used. It was carried out independently of the emergency clinical ultrasonography training of EM residency students after 1 hour of skull bone ultrasonography didactic training. A preliminary statistical study was conducted before the study. SPSS statistical v25 used in data analysis. In the study, frequency (n) and percentage (%) were used as descriptive statistics in the evaluation of categorical variables. "McNemar Chi-square test" or "McNemar Bowker chi-square test" was used to compare CT and US results. There were 335 admissions with head trauma during the specified period. The study population was 32 random cases, the mean age was 81.53±7.99 years, the female rate (n=21) was 65.62%), the male rate (n=11) was 34.38%. The trauma side was on the right side in 46.88% of the cases (n=15), 53.13% in the left line (n=17) and 6.25% in the occipital midline (n=2). On physical exam, the most common region localization was the frontal 53.13% (n=17). Temporal 18.75% (n=6) and parietal 37.50% (n=12) were less common. As a result of tomography, 3 patients had fractures, while 4 patients were vii diagnosed with fractures with PoCUS. 1 patient whose fracture was predicted by PoCUS was confirmed by tomography. Contrarily, 2 cases with fractures detected on tomography could not be predicted by ultrasound. The sensitivity, positive predictive value, negative predictive value was 33.33%, 25% and 92.86% respectively, and the selectivity value was 89.66%.PABAK (Prevalence Adjusted Bias Adjusted Kappa) coefficient was obtained as 0.69. While it is possible that PoCUS is predictive and can rule out fractures, the effect of operator skills and equipment limitations on sensitivity is obvious. Our findings support that PoCUS can rule out skull fractures and reduce unnecessary brain CT scans in selected geriatric cases. Future research requires field-selective studies with a large group involvement. Keywords: Emergency Point-of-Care Ultrasonography; Emergency Medicine; Geriatric head injury.