Introduction of a Pan-scan protocol for blunt trauma activations: what are the consequences?

Abstract Study Objective The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost. Methods A six month prospective study was performed on blunt trauma patients at a Level 1 trauma center. During the last three months of the study a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher's exact test and continuous data were analyzed by Mann–Whitney non-parametric test. Results There were a total of 220 patients in the pre-panscan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the ED by 68.2 minutes (95% CI: −134.4 to −2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI: −2519 to −411). In contrast, fixed CT scan cost increased by $48.1 (95% CI: 32 to 64.1) per patient, however, total radiology cost per patient decreased by $50 (95% CI: −271.1 to 171.4). Additionally, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI: 5.0 to 11.3) greater during the pan-scan period. Conclusion Although there are advantages to whole body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol.