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, Hans‐Georg; Kulla, Martin; Wettberg, M.; Lefering, Rolf; Friemert, Benedikt; Lang, Patricia; Dgu, TraumaRegistrer

doi:10.1007/s00068-017-0870-y

Cited by 15 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rapidly identifying and initiating treatment for life-threatening injuries can improve clinical outcomes for trauma patients; however, such clinically significant injuries are often overlooked in the presence of more obvious external injuries, resulting in delayed diagnoses and contributing to trauma mortality [1][2]. Computed axial tomography (CT) can provide sensitive and specific evaluations of trauma patient injuries [3][4][5][6][7][8]. Innovations in the current generation of CT systems enable improvements in the speed, accuracy, quality, and availability of such injury evaluations [9].…”

Section: Introductionmentioning

confidence: 99%

“…Uniform CT scanning for trauma patients can reduce the rates of missed injuries resulting from an inadequate examination, reducing the rates of avoidable mortality. For these reasons, it may be beneficial to utilize CT imaging as a screening tool in all trauma patients, including those considered to have normal physical examinations [3][4][5][6][7][8]12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Ledrick¹,

Payvandi²,

Murray³

et al. 2020

Cureus

View full text Add to dashboard Cite

Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019. Those patients between the ages of 18 and 65 who were referred to the trauma team with a CT scan of the abdomen and had low-risk mechanisms of injury, a Glasgow Coma Scale (GCS) score of 15, and normal vital signs at presentation were included. Patients in the lowest trauma categorization (Level Three, Consult) met the study definition for the low-risk mechanism of injury. Demographic and clinical data were abstracted for all patients. For this analysis, patients were divided into two groups based on age (18-40 years or 40-65 years). Injuries found on CT, their clinical significance, and the likelihood of being missed without CT were determined. Results Of 2,103 blunt trauma patients that received a CT scan of the abdomen from January 2015 to October 2019, 134/2,103 (6.4%) met the inclusion criteria (mean age: 44.6 years; 72.3% male). Patients between the ages of 40 and 65 years comprised 61.2% (82/134) of the study population. Of the included patients, 17.2% (23/134) had at least one acute traumatic injury identified after CT imaging of the torso. Occult injuries found on CT included rib fracture with associated lung injuries (10/23, 43.5%), splenic laceration (4/23, 17.4%), liver laceration (3/23, 13.0%), gluteal hematoma with active bleeding (1/23, 4.3%), sternal fractures (3/23, 13.0%), and thoracic or lumbar spine fractures (2/23, 8.7%). An independent review of the medical records determined that 9.0% (12/134) of these patients had traumatic injuries that would have been missed based on clinical examination without CT. Conclusions Based on our experience, utilizing CT imaging of at least the abdomen as a routine screening measure for all trauma consults-even low-risk patients with normal vital signs-can rapidly and accurately identify clinically significant injuries that would have been otherwise missed in a notable portion of the population.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Ledrick¹,

Payvandi²,

Murray³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…In addition, the workflow in cases of life-threatening situations as well as the optimization of scan parameters in trauma management needs to be addressed [16]. There are many researchers who show no benefits of WBCT versus selective radiological workup [17][18][19] as well as those who point out many benefits of immediate cross-sectional imaging [20,21]. There are other studies that suggest a selected approach [22].…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

Klempka

Fischer

Kauczor

et al. 2020

Rofo

View full text Add to dashboard Cite

Purpose To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries, assessed using whole-body computed tomography (WBCT), and to determine if these are valid markers for internal injuries. Methods and Materials 250 patients who underwent WBCT emergency scans for suspected polytrauma were retrospectively analyzed after institutional review board approval of the study. The scans were carried out on patients who met the criteria for standard operating procedures for WBCT emergency scans. WBCT covering the entire head, neck, chest, and abdomen (including pelvis and proximal lower extremities) and at least one phase with intravenous contrast agent were included in the study. Initial analyses of immediate WBCT scans was carried out by a consultant radiologist and a radiological resident. The first reading focused on internal damage that needed immediate therapy. The second reading focused on a detailed analysis of the skin and subcutaneous tissue and their relation to internal injuries without the time pressure of an emergency setting, carried out by another experienced radiologist. All skin lesions and the degree of penetration and a comparison between the two readings were reported in tables. Results Superficial lesion of the chest was detected in 19 patients, 17 of them had an internal injury of the thorax while only two patients, with hematoma of the chest wall, had no internal injuries. Skin and subcutaneous lesions of the chest had the strongest association with an internal injury. Skin lesions of the abdominal wall were observed in 30 patients. In only 11 cases, these lesions were correlated with internal injuries, such as fractures or active bleeding. 52 skin and subgaleal lesions of the scalp were observed. In 20 of these patients, an intracranial or internal injury was detected. In 3 patients, skin abrasions of the neck were present and in only one of them, this finding was associated with an internal injury. Conclusion Trauma patients whose history and clinical presentation meet the standard operating procedures for WBCT emergency scans and who present with a cutaneous lesion, especially at the neurocranium or chest wall, should be observed for internal injuries by WBCT. Key Points: Citation Format

show abstract

“…In general, the indication for surgery is set by clinical and radiological diagnosis. The diagnostic work-up for patients with multiple trauma has undergone a paradigm shift from the conventional approach (ultrasound and conventional radiography) to whole-body CT as the first diagnostic tool used in trauma centres [2][3][4][5][6][7]. For this purpose, a CT scanner is located directly in or nearby the resuscitation area of the emergency room or trauma suite.…”

Section: Introductionmentioning

confidence: 99%

Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre

Kippnich

Schorscher

Kredel

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9-34) (median and interquartile range, IQR). tCT was 15 (11-19) minutes (median and IQR) and tOR was 96.5 (75-119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1-6) (median and IQR) and one (0-1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously.

show abstract

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®)

Cited by 15 publications

References 19 publications

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre

Contact Info

Product

Resources

About