A 59-year-old man with type I diabetes, coronary disease, and end-stage renal disease presented to our trauma center after a fall from standing height. In town visiting family, his knees gave way while walking from his hotel to dialysis. He hit his head on the pavement but did not lose consciousness. On evaluation by paramedics at the scene, he was fully alert and had no complaints; blood glucose was 227 mg/dL. Because he was taking clopidogrel, his fall met Centers for Disease Control and Prevention triage criteria1 for transfer to a trauma center. In the emergency department the patient was neurologically intact and asymptomatic; the only external sign of injury was a minor scalp abrasion. Chest and pelvis radiographs were obtained per standard trauma protocol1 in addition to computed tomography (CT) of the head, all of which were negative for acute pathology.
Taylor LJ, Julliard WA, Schwarze ML. Recalculating the Costs of Overtriage: A Teachable Moment. JAMA Intern Med. 2017;177(9):1367–1368. doi:10.1001/jamainternmed.2017.2782
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