Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study

Arch Surg. 2006 May;141(5):468-73; discussion 473-5. doi: 10.1001/archsurg.141.5.468.


Hypothesis: The use of liberal whole body imaging (pan scan) in patients based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury.

Design: Prospective observational study.

Setting: Academic level I trauma center.

Patients: All patients admitted following blunt multisystem trauma.

Intervention: Pan scan, including computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis, with the following inclusion criteria: (1) no visible evidence of chest or abdominal injury, (2) hemodynamically stable, (3) normal abdominal examination results in a neurologically intact patient or unevaluable abdominal examination results secondary to a depressed level of consciousness, and (4) significant mechanisms of injury. Radiological findings and changes in treatment based on these findings were recorded.

Main outcome measure: Any alteration in the normal treatment plan as a direct result of CT scan findings. These alterations include early hospital discharge, admission for observation, operative intervention, and additional diagnostic studies or interventions.

Results: One thousand patients underwent pan scan during the 18-month observation period, of which 592 were evaluable patients with no obvious signs of abdominal injury. Clinically significant abnormalities were found in 3.5% of head CT scans, 5.1% of cervical spine CT scans, 19.6% of chest CT scans, and 7.1% of abdominal CT scans. Overall treatment was changed in 18.9% of patients based on abnormal CT scan findings.

Conclusions: The use of pan scan based on mechanism in awake, evaluable patients is warranted. Clinically significant abnormalities are not uncommon, resulting in a change in treatment in nearly 19% of patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Multiple Trauma / diagnostic imaging*
  • Prospective Studies
  • Reproducibility of Results
  • Tomography, X-Ray Computed*
  • Trauma Severity Indices
  • Whole Body Imaging / methods*
  • Wounds, Nonpenetrating / diagnostic imaging*