Pan scan for geriatric trauma patients: Overkill or necessary?

Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.

Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.

50 ​% of patients had clinically significant CT traumatic findings. Of these, 75 ​% had PE correlating to significant CT findings, while 25 ​% had significant PS findings not identifiable on PE (p ​< ​0.001). The NPV was 0.80 for the PE. 57.7 ​% had clinically significant incidental findings.

Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.