Patterns of referral of trauma patients for pan-scan at Chris Hani Baragwanath Academic Hospital (CHBAH)

Abstract

AIM: To analyse referral letters and findings of pan scans performed at Chris Hani Baragwaneth Academic Hospital (CHBAH) in order to distil those that are most useful in predicting injuries. METHOD: Request forms and reports of pan-scans performed at CHBAH dated between 16/12/2015 and 16/12/2016 were retrieved. Demographics, indications and findings of the pans-scans were recorded and analysed. Pan-scans indications obtained from referral notes were classified into those relating to the mechanism of injury (MOI), clinical examination parameters and emergency room imaging results. RESULTS: A total of 289 patients were enrolled in this study. Most of the patients were male (n=218,75.4%) and young (mean age 33years). Overall, the most common indication for pan-scan was "low GCS" (n=208, 72.0%) and high velocity motor vehicle accidents (MVA) (n=158,54.7%) with most patients having more than one indication (thus indications do not add up to 100%). The most frequent finding was in the chest (n=180, 62.3%) with lung contusions and rib fractures contributing (n=123) 68.5% of this. Head injuries (n=145,50.2%) consisting of surface collections (n=40,28.0%) and brain contusions (n=30,20.8%) followed. There were 39.8%(n=115) incidental findings. There were a few weak but statistically significant correlations between the different indications cited on pan-scan referral with findings by body region. PVA was associated with injuries in more body regions than all the other indications (p<0.0001). Abnormalities were detected in 83.4% (n=241) of the scans. 16.6% (n=49) scans were completely normal. 21.8% (n=63) of the scans had abnormality in only one body region, 27.7% in 2 body regions and 24.2% in 3 body regions or more. CONCLUSIONS: The results of this study appear to indicate a high yield of pan-scan and thus at face value appropriate use. It must be understood however, that these results do not take into consideration the severity of injuries. But the indications are too widely varied and for the most part non-specific, failing to highlight any specific injury patterns that the radiologist needs to look out for when dealing with the referrals. Indications for pan-scan need to be more standardised to allow more efficient use of the limited resources