Whole-Body CT Utilisation in Adult Trauma: Guideline Compliance, Incidental Findings, and the Role of Anticoagulation in Low-Energy Falls at a Regional New Zealand Centre.

INTRODUCTION: Whole-body CT (WBCT) is central to major trauma assessment, but indiscriminate use carries a substantial radiation burden. The Central Region Trauma Network's Early Radiological Imaging in Major Trauma Guideline (CPG154), adopted at this centre, specifies criteria for WBCT and excludes low-energy falls from standing height. This pilot audit evaluated WBCT practice against CPG154 at a regional New Zealand emergency department. METHODS: All adult trauma WBCT scans performed between 2 September and 31 October 2025 were reviewed retrospectively against three predefined standards: Criteria compliance (S1, target ≥ 90%); chest radiograph (CXR) before WBCT (S2, ≥ 95%); and documented follow-up of incidental findings (S3, 100%). RESULTS: Of 73 scans identified, 70 were included. S1 compliance was 47.1% (33/70; 95% CI 35.9%-58.7%). Twenty-two scans (31.4%) were standing-height falls, which CPG154 excludes; among the remaining 48 cases, compliance was 68.8% (33/48). S2 compliance was 15.7% (11/70). Incidental findings occurred in 32.9% (23/70), all with documented follow-up (S3 100%). Acute traumatic injury was identified in 57.6% (19/33) of criteria-compliant scans and 27.3% (6/22) of standing-height fall scans. All six standing-height fall injuries occurred in patients taking anticoagulant or antiplatelet agents; none occurred in the seven patients taking neither (0/7). CONCLUSIONS: Criteria compliance was below target, principally because the standing-height exclusion was not applied at the point of request. The concentration of injuries among antithrombotic-treated fallers is hypothesis-generating and supports prospective evaluation of antithrombotic status as a possible clinical modifier.