The value of whole-body computed tomography imaging in geriatric trauma patients

Introduction and Aim In the assessment of trauma patients of all ages, initial evaluation is based on vital signs and physical examination findings, followed by laboratory results as time progresses. However, in geriatric patients, due to altered physiology, comorbidities, and the use of various medications, the threshold for ordering laboratory tests and imaging such as computed tomography, as well as the decision to monitor patients in the hospital, tends to be lower. This leads to increased radiation exposure during imaging, longer hospital stays, higher healthcare costs, and greater emergency department (ED) crowding. The aim of this study is to investigate the association between physical examination findings and whole-body computed tomography (WBCT) findings in patients aged 65 and over who have either no head trauma or mild head trauma but present with a normal level of consciousness (GCS: 13–15). This is compared with patients aged 18–65. We also aim to compare the outcomes of WBCT imaging in both age groups in terms of discharge, hospitalization, emergency surgical intervention, and mortality, in order to evaluate the significance of WBCT in geriatric trauma patients. Materials and Methods This is a prospective observational study. Patients aged 18 and above who presented to the Emergency Department of Pamukkale University Hospital due to trauma between July 2023 and June 2024, who underwent WBCT imaging, and met the inclusion criteria were included in the study. Demographic data, physical examination findings, laboratory and imaging results, ED outcomes, and the need for surgical intervention were recorded. Patients were divided into two groups: those aged 65 and older and those between 18–65 years. Comparative analyses were conducted between these groups. Additionally, factors affecting computed tomography (CT) and surgical needs were also compared. Results Of the 803 patients included in the study, 219 (27.3%) were aged 65 and over, comprising the geriatric patient group. In both groups, male gender was more prevalent. In the comparison between the two groups, geriatric trauma patients had more general and pelvic physical examination findings, lower hemoglobin, hematocrit, and platelet levels, and significantly higher blood urea nitrogen and creatinine levels compared to non-geriatric patients (p <0.05). Trauma-related cranial, cervical, thoracic, abdominal, and pelvic (CT) findings were significantly more common in geriatric trauma patients than in non-geriatric ones (p <0.05). No significant difference was observed between the two groups regarding the need for surgical intervention (p >0.05). Logistic regression analyses showed that in the non-geriatric population, heart rate significantly influenced the risk of having general physical examination findings, cranial, abdominal, and pelvic physical examination findings, as well as the risk of requiring general and abdominal surgical interventions (p <0.05). In both groups, patients with abdominal physical examination findings were significantly more likely to have thoracic and pelvic CT abnormalities (p <0.05). Geriatric trauma patients who underwent WBCT imaging were found to have significantly higher rates of hospital and intensive care unit admissions due to detected pathologies, compared to non-geriatric patients (p <0.05). Conclusion In our study, although no significant difference was observed between the geriatric and non-geriatric patient groups in physical examination findings of any anatomical region other than the pelvic region, we detected more pathological findings in cranial, thoracic, abdominal, and pelvic CT scans in geriatric trauma patients. Although there was no significant difference between the two groups in terms of the need for cranial, cervical, thoracic, abdominal, or pelvic surgical interventions, geriatric patients were found to be admitted to inpatient wards and intensive care units more frequently than non-geriatric patients, likely due to the findings obtained from WBCT imaging. In the non-geriatric population, heart rate was found to significantly increase the risk of WBCT findings, cranial, abdominal, and pelvic CT findings, as well as the need for general and abdominal surgical interventions. However, in geriatric trauma patients, heart rate was not associated with any CT finding or surgical need, suggesting it may not be a reliable parameter in this patient group. The fact that fewer parameters influence CT findings and surgical needs in geriatric trauma patients compared to non-geriatric patients may weaken the ability to predict serious pathologies. Finally, based on our results, just as in non-geriatric trauma patients, the presence of abdominal physical examination findings in geriatric patients also increases the risk of thoracic and abdominal CT findings. Therefore, we recommend that patients with abdominal physical examination findings be evaluated not only with abdominal CT but also with thoracic and pelvic CT imaging.