Rethinking the pan scan in stable trauma: A comparison of whole-body computed tomography and selective imaging in...

To compare the frequency of clinically significant missed injuries in clinically stable trauma patients undergoing initial whole-body computed tomography (WBCT) versus selective imaging. Secondary objectives include comparisons of radiation exposure, incidental findings, ED length of stay (LOS), hospital LOS and mortality.

We performed a retrospective cohort study of trauma activations at a tertiary trauma centre in patients with normal vital signs from 1st January 2022 to 31st December 2022. Data were collected from the trauma registry and chart review of medical records.

A total of 665 patients were included with 42% (n = 277) receiving a WBCT, compared to 58% (n = 388) undergoing selective imaging. Most patients (52%) did not have any traumatic axial injuries identified. Missed injuries were identified in 0.8% (n = 3/388) of patients in the selective imaging cohort, with no adverse patient outcomes or major alteration to inpatient management. No missed injuries were identified in the WBCT group. Mortality was rare (0.9%, n = 6/665), occurring exclusively in elderly patients and mostly attributed to non-traumatic pathologies. Patients undergoing WBCT had a significantly increased likelihood of incidental findings (75% vs 35%, P < 0.001), increased radiation exposure (mean 24.67 vs 8.19 millisieverts [mSv], P < 0.001), longer ED LOS (9.86 vs 8.43 h, P = 0.012) and a higher likelihood of admission (65.3% vs 55.7%, P = 0.012).

Missed injuries were rare and without major complications in this clinically stable cohort. The liberal use of WBCT, despite low rates of missed injuries, morbidity and mortality, suggests over-utilisation of WBCT for 'mechanism only' traumas.