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E1600. Clinical and Radiographic Findings in Geriatric Assault
Authors
  1. Mihan Lee; New York Presbyterian Hospital; Weill Cornell Medical Center
  2. Kriti Gogia; New York Presbyterian Hospital; Weill Cornell Medical Center
  3. Jessica Rotman; New York Presbyterian Hospital; Weill Cornell Medical Center
  4. Sunday Clark; New York Presbyterian Hospital; Weill Cornell Medical Center
  5. Pallavi Sagar; Massachusetts General Hospital
  6. Jennifer Uyeda; Massachusetts General Hospital
  7. Tony Rosen; New York Presbyterian Hospital; Weill Cornell Medical Center
Objective:
Assault on older adults is surprisingly and disturbingly common; however, it can be difficult to recognize in clinical settings, as its presentation can closely mimic that of frail geriatric patients after minor trauma (eg, fall). Identifying radiographic findings of geriatric injury after assault may improve identification of these patients, and ultimately aid in the recognition of physical elder abuse. Our objective was to describe common imaging findings seen in cases of geriatric assault in the Emergency Department (ED) setting.

Materials and Methods:
We conducted a case series of assault in patients aged >60 performed in 3 urban, academic EDs from 2007-2017. We identified cases using keyword searches of radiology report databases. For each case, patient demographics and details of the assault were abstracted from the chart, and all imaging studies undergone were reviewed for positive findings by a radiology member of the research team.

Results:
We examined 292 cases of geriatric assault, with a median age of 66 (interquartile range, 62-72) and the majority of victims male (65.4%). 41.8% of cases met criteria for physical elder abuse, based on the relationship between victim and perpetrator. Mechanisms of injury were most commonly blunt force (79.8%) or the victim was pushed/fell (10.3%). Assailants used body parts as weapons most commonly (67.8%), usually the hand/fist (62.7%). A median of 2 imaging studies were ordered per patient (interquartile range, 1-4). Most commonly ordered images included: CT head (70.1% of cases), chest x-ray (40.1%), CT cervical spine (34.4%), CT face (32.3%), and upper extremity radiographs (21.5%, most commonly of the shoulder, wrist, and hand). Overall, 20.1% of imaging studies ordered demonstrated an acute, trauma-related finding, with 75.4% of these located in the head/face and upper extremities. Positive findings were seen in 32.9% of all head/face studies ordered and 36.5% of all upper extremity images ordered. The most common findings in the head/face were subdural hematoma, nasal fractures, and mandibular fractures, while the most common positive findings in the upper extremity were distal radial and ulnar fractures. Head/face injuries were moderately lateralized to the left, as would be expected from facing a right-handed assailant, while extremity injuries were not similarly lateralized. Finally, preliminary analyses suggested that an elderly patient presenting to the ED following an episode of elder abuse was equally likely to have a positive radiographic finding as if they were assaulted by a stranger.

Conclusion:
This case series analysis presents common radiographic injury patterns seen in victims of geriatric assault. Identifying these patterns may help diagnostic radiologists fine-tune their search pattern when reading cases of elder trauma, and ultimately serve as a first step in improving their sensitivity for physical elder abuse. In this way, radiologists may become better incorporated into the multidisciplinary effort to detect and manage elder abuse, alongside emergency medicine physicians, geriatricians, and social workers.