Pan scan for geriatric trauma patients: Overkill or necessary?

Area of Science:

• Trauma care
• Geriatric medicine
• Diagnostic imaging

Background:

• Elderly patients present pain and physical findings differently, leading to higher mortality and complications.
• Physical examination (PE) may be unreliable for comprehensive injury identification in geriatric patients.
• Incidental radiologic findings in this population require quantification.

Purpose of the Study:

• To evaluate the reliability of physical exam versus computed tomography (CT) for identifying injuries in geriatric trauma patients.
• To quantify significant incidental radiologic findings in this demographic.
• To support the use of Pan Scan (PS) CT in geriatric trauma care.

Main Methods:

• Instituted a policy of Pan Scan (PS) CT for trauma activations in patients aged 65 years and older.
• PS included CT scans of the head/neck and chest/abdomen/pelvis.
• Extracted and analyzed physical exam and imaging findings from physician reports.

Main Results:

• 50% of geriatric trauma patients had clinically significant CT traumatic findings.
• 25% of significant CT findings were not identifiable on physical exam (p < 0.001).
• 57.7% of patients had clinically significant incidental findings on PS CT.

Conclusions:

• Physical examination alone is insufficiently sensitive for detecting all traumatic injuries in elderly patients.
• Pan Scan (PS) CT offers the added benefit of identifying important incidental findings.
• These findings support the use of PS CT to optimize care for geriatric trauma patients.