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The following is a summary of “Pan Scan for Geriatric Trauma Patients: Overkill or Necessary?,” published in the February 2025 issue of American Journal of Surgery by Thomas et al.

Patients with geriatric trauma often present with atypical pain responses and subtle physical examination (PE) findings, making accurate injury identification challenging. Given the increased risk for mortality and complications, researchers hypothesized that PE alone is unreliable compared to computed tomography (CT) for detecting traumatic injuries in this population. Additionally, the study group sought to quantify the prevalence of significant incidental radiologic findings identified through imaging. This study was conducted at a single institution where a policy of Pan Scan (PS) CT was implemented for all trauma activations involving patients aged 65 years or older. 

The PS protocol included CT imaging of the head, neck, chest, abdomen, and pelvis. Physician reports were analyzed to extract PE findings and corresponding imaging results. Among the studied cohort, 50% of patients had clinically significant traumatic findings on CT. Of these, 75% had PE findings that correlated with their CT results, whereas 25% had significant traumatic injuries detected exclusively on PS and not identifiable through PE alone (P<0.001). The negative predictive value (NPV) of PE for ruling out significant traumatic injury was 0.80, highlighting its limitations. Additionally, 57.7% of patients had clinically significant incidental findings on CT, underscoring the added diagnostic value of PS in geriatric trauma care. 

These results demonstrate that PE alone lacks sufficient sensitivity for detecting all traumatic injuries in elderly patients. The implementation of PS not only improves injury detection but also facilitates the identification of clinically relevant incidental findings that may impact long-term patient management. These findings support the routine use of comprehensive imaging protocols in geriatric trauma to optimize diagnostic accuracy and enhance patient outcomes.

Source: americanjournalofsurgery.com/article/S0002-9610(25)00031-5/abstract