Imaging recommendation · Musculoskeletal

Fall in elderly patient — imaging triage

Q: What's the alternative imaging for fall in elderly patient — imaging triage when head strike or anticoagulated?

CT — CT head without contrast (see anticoag-fall, head-trauma) (no contrast).

Q: What's the alternative imaging for fall in elderly patient — imaging triage when cervical pain / neuro deficit / unable to clinically clear c-spine?

CT — CT C-spine (see cspine-alert, cspine-obtunded) (no contrast).

Q: What's the alternative imaging for fall in elderly patient — imaging triage when hip pain — radiograph negative?

MRI — MRI hip — occult fracture (see occult-hip-fx) (no contrast).

Q: What's the alternative imaging for fall in elderly patient — imaging triage when pelvic pain — concern for sacral / pubic ramus fracture?

CT — CT pelvis or MRI pelvis (see sacral-stress-fx, pelvic-trauma) (no contrast).

Q: What's the alternative imaging for fall in elderly patient — imaging triage when vertebral compression — back pain post-fall?

XR — Thoracolumbar XR; MRI if persistent or neuro deficit (see vertebral-compression-fx) (no contrast).

Recommended: Region-targeted XR / CT based on point tenderness + mechanism is the preferred imaging study for fall in elderly patient — imaging triage. Imaging is targeted by complaint + exam: CT head if head strike, anticoagulated, or any focal deficit / amnesia.

Recommended study

Region-targeted XR / CT based on point tenderness + mechanism

XR No contrast Preferred Musculoskeletal EmergencyAcute inpatient Reviewed 2026-05

Imaging is targeted by complaint + exam: CT head if head strike, anticoagulated, or any focal deficit / amnesia. C-spine CT when NEXUS / Canadian criteria fail. Hip / pelvis XR for hip or pelvic pain — MRI if XR is negative and pain persists (occult hip fracture). Extremity XR per point tenderness. Reflexive pan-scanning is low-value in mechanical ground-level falls without specific concerns.

If the default doesn't apply

Head strike or anticoagulated

CT CT head without contrast (see anticoag-fall, head-trauma) No contrast

Cervical pain / neuro deficit / unable to clinically clear C-spine

CT CT C-spine (see cspine-alert, cspine-obtunded) No contrast

Hip pain — radiograph negative

MRI MRI hip — occult fracture (see occult-hip-fx) No contrast

Pelvic pain — concern for sacral / pubic ramus fracture

CT CT pelvis or MRI pelvis (see sacral-stress-fx, pelvic-trauma) No contrast

Vertebral compression — back pain post-fall

XR Thoracolumbar XR; MRI if persistent or neuro deficit (see vertebral-compression-fx) No contrast

Watch-outs

Don't pan-scan reflexively

Image regions with point tenderness, deformity, or neuro deficit. Non-targeted CT chest/abd/pelvis is rarely indicated unless mechanism warrants polytrauma evaluation.

Anticoag + head strike

Image regardless of GCS — delayed bleeds are common and clinical exam can be misleading.

Occult hip fracture

Up to 5% of elderly hip fractures are radiographically occult — MRI within 24 h if pain persists and weight-bearing is impossible.

Pearls

ACR Appropriateness for falls in elderly: targeted XR ± CT is the high-value pathway.
Sacral insufficiency fracture on bone scan / MRI: 'H-shaped' Honda sign.
Recurrent falls warrant gait + balance evaluation, not more imaging.