Assessing the Utility and Safety of Intravenous Iodinated Contrast Media in CT 'Pan Scan' Studies in Geriatric...

Ground level falls are common in the geriatric population, often culminating in Emergency Department attendance and a CT 'pan scan'. These scans are routinely performed with intravenous iodinated contrast media (ICM). The types of injuries identified in this cohort can often be adequately characterised without ICM. Safety issues exist with ICM use, with contrast-induced acute kidney injury (CI-AKI) particularly relevant to the geriatric population. This study assessed the diagnostic utility and safety of ICM administration in this cohort.

A retrospective case control study of geriatric patients undergoing CT pan scan over a 6-month period was performed. Patients were included if they had suffered a ground level fall. The radiology report for each patient was reviewed to assess injury types. The creatinine of each patient who received ICM was assessed to determine the presence of CI-AKI.

A total of 549 patients were included in the final analysis. Two hundred four patients suffered at least one traumatic injury. The majority of injuries were musculoskeletal and spinal, with solid organ and vascular injuries only occurring in a small minority. Injuries were more frequently reported on non-contrast studies. 15.4% of patients suffered a CI-AKI.

Given the types of injuries identified in geriatric patients following low-energy blunt trauma, and when considering CI-AKI and other costs, routine use of ICM on CT pan scans in this population is not necessary. Reserving ICM studies only for patients deemed clinically high risk or with radiologically concerning findings on an initial non-contrast CT is a reasonable compromise.