In the shadow of stability lies ruin: Occult vascular injuries in geriatric pelvic trauma

Table 1 Risk-based model for computed tomography angiography utilization in elderly patients with suspected pelvic injury

Risk category	Criteria	Recommended imaging approach
High risk	Hemodynamic instability, ongoing transfusion requirement, anticoagulant use (e.g., warfarin, DOACs), delayed presentation (> 48 hours), cognitive impairment with unexplained anemia or clinical deterioration	Immediate CTA of the abdomen and pelvis with early consideration for repeat imaging if clinical trajectory worsens
Intermediate risk	Stable hemodynamics but presence of high-risk features: Frailty, minor trauma with early hemoglobin drop, cognitive impairment, or multi-drug therapy	Consider early CTA; monitor clinical and laboratory trends closely
Low risk	No anticoagulation, early presentation, normal mental status, stable hemoglobin, and no concerning clinical features	Observation with serial exams and labs; CTA only if deterioration occurs

DOACs: Direct oral anticoagulants. CTA: Computed tomography angiography.