Pan CT for blunt polytrauma - Is there a need for more selective indications?

Pan computed tomography (CT) has become ubiquitous in the evaluation of patients with blunt polytrauma. The indications for Pan CT were previously evaluated in our unit and judicious use was demonstrated. Since CT has become increasingly readily available, we questioned whether "indication creep" has occurred in our unit. We aimed to determine, based on local imaging criteria, whether Pan CT is being over-utilised within our trauma service.

We performed a retrospective review of all pan scans conducted in our unit in Pietermaritzburg, South Africa, during a 5-year period, January 2017 to December 2021. Data was analysed to determine injuries identified on Pan CT and how these findings influenced patient management.

Of 301 pan scans, 269 (89.4%) prompted an intervention, including brain scans (47.2%), cervical spine scans (9.3%), chest scans (22.7%) and abdominal scans (20.8%). The remaining 32 pan scans (10.6%) did not influence management. Many of these "clinically negative" scans were clinically important, ruling out injury in patients in whom clinical assessment was regarded as unreliable: 5 patients (1.7%) were hypoxic and had to be sedated, intubated and ventilated; 8 (2.7%) had a Glasgow Coma Score < 15; and 4 (1.3%) had major distracting injuries. This left only 15 pan scans (4.98%) that were not regarded as clinically helpful.

In comparison with the results from a previous report from our unit, "indication creep" has not occurred. We continue to have fewer than 5% of patients who may be considered for imaging modalities other than Pan CT.