Whole body CT-scan vs. selective CT-scan in geriatric trauma: Systematic review and meta-analysis

Abstract

Introduction

Geriatric trauma is a burgeoning public health problem. In Australia and New Zealand, there has been a 21% increase in geriatric major trauma presentations over the past 4 years, with persons over 65 year-of-age now accounting for almost one third of all severely injured patients. Whole-body computed tomography (WBCT) is often used in the emergency department to assess patients for traumatic injuries. Recent studies have suggested more selective use of WBCTs for trauma patients, but the benefit of WBCTs in older persons is undefined. This systematic review aims to identify whether geriatric trauma patients that underwent WBCT have different outcomes compared to those that have selective CT-scans.

Methods

A systematic literature search was conducted on PubMed, MEDLINE and EMBASE according to the PRISMA guidelines for studies about imaging in geriatric trauma from 1946 to June 2023. Outcomes of patients that had WBCT were compared with those that had selective CT scans on presentation.

Results

Five publications including 14,908 geriatric trauma patients were reviewed for analysis. Analysis of mortality showed that WBCTs are not significantly associated with a reduced risk of mortality (OR: 0.88, 95% confidence interval [CI] 0.46–1.67, p = 0.69). Analysis of hospital length of stay showed that patients investigated with WBCTs had no significant difference to patients that had selective CT scans (MD: −0.39, 95% CI −1.09 to 0.30, p = 0.27). WBCTs also are not associated with a higher likelihood of being discharged home (OR: 1.05, 95% CI 0.56–1.98, p = 0.87).

Conclusion

WBCTs are not associated with reduced mortality, reduced hospital or ICU LOS or discharge destination in geriatric trauma when compared to selective CT-scans. There is presently insufficient evidence to support a routine approach of WBCT in the assessment of geriatric trauma patients.

Keywords

Geriatric trauma Whole-body CT scan resource allocation

Get full access to this article

View all access options for this article.

References

Kania

Pandya

Demissie

, et al. Physical exam is not an accurate predictor of injury in geriatric patients with low-energy blunt trauma – a retrospective cohort study. Ann Med Surg (Lond) 2022; 81: 104503.

Australia New Zealand Trauma Registry. Australia New Zealand Trauma Registry Annual Report 2021. 2022. https://static1.squarespace.com/static/5b761ed3f93fd491065f7839/t/639a85aa5aac7405c9cd89ee/1671071179741/ATR_Annual-Report_20-21.pdf

Atinga

Shekkeris

Fertleman

, et al. Trauma in the elderly patient. Br J Radiol 2018; 91: 20170739.

Sterling

O’Connor

Bonadies

. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 2001; 50: 116–119.

Kim

, et al.

Is a “pan-scan” indicated in the older patient with a ground level fall?

Am Surg 2018; 84: 1480–1483.

Slim

Nini

Forestier

, et al. Methodological Index for non-randomised studies (MINORS): development and validation of a new instrument. ANZJS 2003; 73: 712–716.

Dwyer

Scifres

Stahlfeld

, et al.

Radiographic assessment of ground-level falls in elderly patients: is the “PAN-SCAN” overdoing it?

Surgery 2013; 154: 816–822.

Penasco

Sanchez-Arguiano

Gonzalez-Castro

, et al. Whole-body computed tomography as a factor associated with lower mortality in severe geriatric trauma with thoracic-abdominal-pelvic injury. Rev Esp Anestesiol Reanim 2018; 65: 323–328.

Lepkowsky

Simcox

Rogoff

, et al.

Is there a role for CT WBCTs in the initial workup of fragility fracture patients?

Geriatr Orthop Surg Rehabil 2020; 11: 1–6.

10.

Mohamed

Teoh

. Outcome of selective CT vs. pan-CT scan in elderly trauma patients: a retrospective cohort study in a level 1 trauma center. Chin J Traumatol 2021; 24: 249–254.

11.

Pearcy

Grossman Verner

Figueroa

, et al. Appropriate imaging for geriatric trauma. Am Surg 2023; 89(11): 4931.

12.

Caputo

Stahmer

Lim

. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014; 77: 534–539.

13.

Broder

Warshauer

. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol 2006; 13: 25–30.

14.

Gunn

, et al. Improving outcomes in the patient with polytrauma: a review of the role of whole-body computed tomography. Radiol Clin North Am 2015; 53: 639–656. vii.

15.

Sierink

Treskes

Edwards

, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet 2016; 388: 673–683.

16.

Salim

, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006; 141: 468–475.

17.

Gartin

, et al.

Injury patterns and incidence of intra-abdominal injuries in elderly ground level fall patients: is the PAN-SCAN warranted?

Am J Surg 2019; 218: 847–850.

18.

Jiang

Zhang

. Who will benefit from whole-body computed tomography? Am J Emerg Med 2016; 34: 1907–1908.

19.

Brenner

Elliston

. Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004; 232: 735–738.

20.

Wutzler

Marzi

. Routine total-body CT for trauma room patients-life saver or needless radiation exposure? J Thorac Dis 2016; 8: 3040–3041.

21.

Niedermeier

, et al. Incidental CT fidnigns in the elderly with low-energy falls: prevalence and implications. Diagnostics (Basel) 2022; 12: 54.

22.

Bahl

Schafer

. Utility of abdominal computed tomography in geriatric patients on warfarin with a fall from standing. J Emerg Trauma Shock 2018; 11: 88–91.

23.

Booth

, et al. Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 2010; 83: 456–465.

24.

Andrawes

, et al.

CT scan incidental findings in trauma patients: does it impact hospital length of stay?

Trauma Surg Acute Care Open 2017; 2: e000101.

25.

Ganguli

, et al. Cascades of care after incidental findings in a US national survey of physicians. JAMA Netw Open 2019; 2: e1913325.

26.

Treskes

Sierink

Edwards

, et al. Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial). Br J Surg 2021; 103: 277–285.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB