title: Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences?
abstract: 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 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test.
  
  
  RESULTS
  There were a total of 220 patients in the pre-pan-scan 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 emergency department by 68.2 minutes (95% confidence interval [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 computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, -271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: mjames3@jhmc.org.
authors: Melissa K
authors: MK
authors: James
authors: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY; Department of Surgery, University of California at Irvine Medical Center, Orange, CA. Electronic address: sschubl@gmail.com.
authors: Sebastian D
authors: SD
authors: Schubl
authors: Ross University, School of Medicine, Dominica, WI. Electronic address: mikefrancois3@gmail.com.
authors: Michael P
authors: MP
authors: Francois
authors: Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY; Department of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: gdoughli@jhmc.org.
authors: Geoffrey K
authors: GK
authors: Doughlin
authors: Department of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: slee@jhmc.org.
authors: Shi-Wen
authors: SW
authors: Lee
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*; D051598:Whole Body Imaging / Q000191:economics / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery