Pan-scan for trauma patients at the emergency department

Background Pan-scan, which comprises computed-tomography (CT) scans of the head, cervical spine, chest, abdomen and pelvis, allows for the rapid evaluation of life-threatening injuries. We aimed to describe the utilisation of pan-scan in trauma patients in the Emergency Department (ED) of a level 2 trauma centre for detection of clinically significant injuries and their subsequent management. Methods This was a retrospective study involving trauma patients attended to by the hospital trauma team at the ED from 18 August 2018 to 31 December 2022. Information on demographics, mechanism of injury, injuries sustained, injury severity score (ISS), pan-scan findings, clinical management and outcome were collected and analysed. Results Among 496 patients, pan-scan was performed in 129 of them (26.0%). Eighty (62.0%) patients had pan-scans that were positive with clinically relevant findings, the top three findings were rib fractures, intracranial hemorrhage and vertebral fractures. Eighteen (22.5%) patients with positive pan-scans underwent intervention, of which the most common was craniectomy/craniotomy and/or intracranial pressure monitor insertion in the operation theatre. Patients with pan-scan had a longer median length of stay at the ED 113 minutes (interquartile range (IQR) 75.5 to 156.5 minutes) than those without 93 minutes (IQR 63 to 136 minutes) but this was not statistically significant when corrected for ISS ( p = .089). The mortality rate for patients with pan-scan performed was 5.4%. Conclusion The proportion of patients with pan-scan performed was low and most of the findings did not require intervention. Considering the purpose of pan-scan to the patient, clinician and trauma system, as well as adaptation of existing criteria for pan-scan are necessary to better identify patients who would benefit from it.