An evaluation of the use of whole-body computed tomography in trauma patients at a United Kingdom trauma centre

Venugopal, Kuhan; Kinghorn, Alison F.; Emordi, Curtis E.; Atkinson, Paul; Kendall, Richard

doi:10.1097/mej.0b013e32834ada14

Cited by 8 publications

(2 citation statements)

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“…First, the routine use of WBCT resulted in significant information gain in comparison to single as well as 'complete CI', valid for both, injury and incidental findings: In almost every second patient at least one finding was missed by CI only. Our data correlate well with earlier publications reporting a poor correlation of clinical and conventional radiological diagnoses compared to injury-related findings detected by WBCT [5,[21][22][23][24][25]. A rate of 65% of undetected injuries in CXR compared to CT was reported in a smaller prospective study on blunt chest trauma [26].…”

Section: Discussionsupporting

confidence: 90%

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

Magyar

Maeder

Diepers

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI). Methods Prospective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square). Results 1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regions was underestimated by CI on average by an AIS of 1.9 (p < 0.001). In 22.0% of cases injury severity increased by an AIS ≥ 2 following WBCT. In 16.8% of patients additional injury findings resulted in a change of treatment (number needed to profit, NNP = 6 patients): NNP decreased from 25 for patients with an ISS < 7 up to nearly 2 for patients with an ISS > 25 at final evaluation, thereby demonstrating a significant improvement in the NNP with increasing ISS (rho = 0.33, p < 0.001). Moreover, WBCT in 88.4% of patients identified ≥ 1 incidental finding (mean 3.4) vs. 28.9% by CI only (p < 0.001). Overall, WBCT had treatment consequences in 31.9% of cases (NNP = 3.1). Conclusions The application of WBCT in addition to CI in the emergency treatment of trauma had therapy consequences for almost every third patient. On the other hand, WBCT appeared not to be indicated (ISS < 8) in at least 2/5 of patients.

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Section: Discussionsupporting

confidence: 90%

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

Magyar

Maeder

Diepers

et al. 2020

Eur J Trauma Emerg Surg

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“…Whole body computed tomography (WBCT) in the multiply injured patient is a valuable tool that can be used to assess the severity of trauma and determine prioritization in the course of treatment [1]. Using this tool, vertebral lesions are detected and routinely classified.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Sagittal Spine Lordosis by Supine Computed Tomography and Upright Conventional Radiographs in Patients with Spinal Trauma

Bouaicha

Lamanna

Jentzsch

et al. 2014

BioMed Research International

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Study Design. Retrospective data analysis. Objective. To compare the sagittal lordosis of the lumbar spine by supine computed tomography (CT) and upright conventional radiographs. Summary of Background Data. There is sparse data about position and modality dependent changes of radiographic measurements in the sagittal lumbar spine. Methods. The anatomical and functional Cobb angles of the thoracolumbar spine in 153 patients with spinal injury were measured by conventional upright sagittal radiographs and supine CT scans. Patients were assigned either to group A (n = 101), with radiologically confirmed vertebral fractures, or to group B (n = 52), without any osseous lesions. The interchangeability of the two imaging modalities was calculated using a ±3° and 5° range of acceptance. Results. Group A showed a mean intraindividual difference of −3.8° for both the anatomical and the functional Cobb angle. Only 25.7% and 27.7% of the 101 patients showed a difference within the tolerated ±3° margin. Using the ±5° limits, only 46 and 47 individuals fell within the acceptable range, respectively. In the patients in group B, the mean intraindividual difference was −2.1° for the anatomical and −1.5° for the functional Cobb angle. Of the 52 patients, only 14 and 13 patients, respectively demonstrated an intraindividual difference within ±3°. With regard to a threshold of ±5°, both the functional and anatomical values were within the defined margins in only 25 (48%) patients. Conclusion. The use of supine CT measurements as a baseline assessment of the sagittal lordosis of the injured thoracolumbar spine does not appear to be appropriate when upright conventional sagittal plane radiographs are used for follow-up measurements.

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Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®)

Palm

Kulla

Wettberg

et al. 2017

Eur J Trauma Emerg Surg

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An evaluation of the use of whole-body computed tomography in trauma patients at a United Kingdom trauma centre

Cited by 8 publications

References 0 publications

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

Comparison of the Sagittal Spine Lordosis by Supine Computed Tomography and Upright Conventional Radiographs in Patients with Spinal Trauma

Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®)

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