Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Abstract

In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist’s expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries.

Impact of COVID-19 Pandemic on the Workload of Diagnostic Radiology: A 2-Year Observational Study in a Tertiary Referral Hospital

“…This allowed to organize dedicated imaging sessions for COVID-19 patients admitted in the ED or already hospitalized, while some scanners remained COVID-free to ensure safe examinations, especially for surgical and oncological patients. Another factor influencing the increased CT workload, especially in the second half of 2021, was the more extensive use of split-bolus CT for minor trauma patients (30) to reduce observational periods and address the need for rapid discharge from the overburdened ED. As opposed to CT imaging, XR workload was reduced in all but the last pandemic wave, including chest XR.…”

Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities

“…Therefore, after an inhomogeneous area is detected, it is useful to add CD-US evaluation to confirm the presence of a laceration before CECT. 14 In the setting of minor or localized trauma, a CECT exam is usually performed following the identification of free fluid in the abdominal cavity or signs suspected for organ injuries at US, in order to assess the extent of organ injury. Contained vascular injuries, such as intrasplenic pseudoaneurysms and arteriovenous fistula, are recognized, albeit rare complications of splenic trauma, which can be identified at CD-US and confirmed at CECT 15 injuries with levels of accuracy similar to those that CECT (Figure 12).…”

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

“…Computed Tomography (CT) represents the “gold standard” imaging technique in the first-line evaluation of polytraumatized patients [ 1 , 2 , 3 ], as it ensures high diagnostic accuracy, rapid execution time, and hospital availability; however, once the diagnosis is made and the patient is stable, a series of possibilities open up regarding the best diagnostic imaging tool to choose for monitoring the diagnosed lesions or detecting complications, depending on the involved anatomical structures, the grade of each injury, and the availability and expertise of each imaging method [ 4 , 5 , 6 , 7 , 8 ].…”