Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center.

PURPOSE

There are currently no clear guidelines for use of pan- or selective CT in elderly trauma patients and this subject matter remains controversial. The aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan- or selective CT scan on admission.

METHODS

The Trauma Audit Research Network database was reviewed to identify eligible patients (≥65 years) over a one-year period, from January 2018 to January 2019. Patients' demographics, mechanism of injury, injury severity score, length of hospital stay (LOS), mortality and type of CT scans done were recorded. The inclusion criteria were elderly patients ≥65 years involved in acute trauma setting (less than one day between incident and emergency department presentation and blunt mechanism of injury). Exclusion criteria were patients <65 years, perforating mechanism of injury and patients with delayed presentation more than one day after the incident, and patients who have not got any CT scan at presentation. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).

RESULTS

In total, 481 patients with the mean age of 80.8 years were evaluated (48.6% male). Among them 232 cases were multiple injuries while 249 were single system injuries. And 235 patients (48.8%) underwent pan-CT in whom 66.8% were multiple injuries; 246 (51.1%) did selective CT scan in whom 69.5% were single system injuries. In multiple injury patients, performing a pan-CT scan on presentation was associated with shorter LOS compared to those who had a selective CT, in which 76.4% patients spent < 21 days in the pan-CT group compared to 16.0% for those investigated by selective CT scan (p < 0.001); and 2.5% spent > 60 days in pan-CT group compared to 64% in selective CT group (p < 0.0001). Performing pan-CT was also associated with lower need to repeat CT (p < 0.01). In patients with a single system injury, no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested.

CONCLUSION

We recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital stay. No difference in LOS or the need to repeat another CT if pan-CT or selective CT were requested initially in single system injuries. Although age and injury severity score are poor predictors for the need to do pan-CT, the mechanism of injury may be helpful.