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.