Einsatz der Mehrschicht-Spiral-CT beim traumatologischen Notfall und ihre Auswirkungen auf den Untersuchungs- und Behandlungsalgorithmus

Boehm, Thomas; Alkadhi, Hatem; Schertler, Thomas; Baumert, Bernhard; Roos, Justus E.; Marinček, Borut; Wildermuth, Simon

doi:10.1055/s-2004-813740

Cited by 54 publications

(6 citation statements)

References 11 publications

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“…Computed tomography is more precise for detecting even small injuries and aids in establishing plans for further therapy. Due to this fact, more and more authors believe that computed tomography is the diagnostic tool of choice for severely injured patients and is superior to other examination protocols [ 7 - 10 ]. The possible advantages of WB-MSCT are the fast imaging of the body regions of primary interest (abdomen, thorax, brain, spine, and pelvis) and the early definition of a treatment plan.…”

Section: Introductionmentioning

confidence: 99%

Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

et al. 2015

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BackgroundWhole-body multislice computed tomography (WB-MSCT) has become an important diagnostic tool in the early treatment phase of severely injured patients. The optimal moment of WB-MSCT’s use during this treatment phase remains unclear. Many trauma centers use WB-MSCT in addition to conventional radiographs, while some trauma centers use WB-MSCT as the only radiological tool. The aim of this study was to determine the differences between these two protocols and to answer the question of whether conventional radiographs can still be used in the safe treatment of polytrauma patients.MethodsPatients from the TraumaRegister DGU® with an injury severity score (ISS) of ≥16 were included. Group I received conventional radiographs and focused assessment with sonography in trauma (FAST) prior to a WB-MSCT, and group II received an initial WB-MSCT and FAST. Both groups were compared concerning treatment time and outcome.ResultsA total of 3,995 patients in group I were compared to 4,025 patients in group II. There were no differences in ISS (29.97 vs. 29.94), gender (male: 73.5% vs. 72.8%), age (45.47 vs. 45.12 years), or calculated mortality (21.41% vs. 21.44%). Time needed in the resuscitation room was slightly longer in group I (72 vs. 64 min); the durations until admittance to the ICU and arrival to the OR were not significantly different between the groups. There was no difference in mortality (18.2% vs. 18.4%) or the standardized mortality ratio (SMR) (0.85 vs. 0.86).ConclusionsWB-MSCT plays an inherent role in the treatment of multiple-injured patients. However, the use of WB-MSCT as the only diagnostic method in the resuscitation room is not needed. Conventional radiographs and FAST followed by WB-MSCT can be performed in the early resuscitation phase without impairing patient outcomes. This approach enables the emergency room team to perform life-saving procedures - chest-tube insertion, laparotomy, cardiopulmonary resuscitation -immediately and simultaneous. Nevertheless, randomized multi-center trials are needed to determine the comparability and effectiveness of these algorithms.

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Section: Introductionmentioning

confidence: 99%

Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

et al. 2015

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“…Ein Algorithmus darf dabei nicht als unabänderliche Handlungsanweisung gesehen Abb. 4 8 Pilot scan zur Planung der MSCT-gestützten Schockraumdiagnostik. Bild einer thorakalen Messerstichverletzung.…”

Section: Abweichungen Vom Algorithmusunclassified

“…Zeitverzögerungen bei der Anlage des Katheters durch unerwartet schwierige Verhältnisse in der täg-lichen Praxis werden regelhaft beobachtet [7]. Demgegenüber liegen zahlreiche Arbeiten vor, die den Nutzen einer möglichst zeitnahen MSCT-Diagnostik im Rahmen der Schockraumversorgung belegen [1,4,9,14,15,18,20,28] …”

Section: Katheteranlageunclassified

Schockraumversorgung von schwer verletzten Patienten

et al. 2009

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“…To evaluate cardiac function with MDCT datasets, many different software tools are commercially available nowadays that rely on the segmentation of the left ventricular blood pool in end-systole and end-diastole for determination of the LV functional parameters. Manual reconstruction of short-axis images from raw MDCT datasets with axial image reconstruction and the manual drawing of endo- and epicardial contours can be very time consuming [14, 15]. Therefore, semi-automatic software tools have been developed using a region-growing segmentation approach, based on the value of the Hounsfield Units (HU) within the LV cavity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of (semi-)automatic and manually adjusted measurements of left ventricular function in dual source computed tomography using three different software tools

Jonge

Ooijen

Overbosch

et al. 2010

Int J Cardiovasc Imaging

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To assess the accuracy of (semi-)automatic measurements of left ventricular (LV) functional parameters in cardiac dual-source computed tomography (DSCT) compared to manually adjusted measurements in three different workstations. Forty patients, who underwent cardiac DSCT, were included (31 men, mean age 58 ± 14 years). Multiphase reconstructions were made with ten series at every 10% of the RR-interval. LV function analysis was performed on three different, commercially available workstations. On all three workstations, end-systolic volume (ESV), end-diastolic volume (EDV), LV ejection fraction (LVEF) and myocardial mass (MM) were calculated as automatically as possible. With the same DSCT datasets, LV functional parameters were also calculated with as many manual adjustments as needed for accurate assessment for all three software tools. For both semi-automatic as well as manual methods, time needed for evaluation was recorded. Paired t-tests were employed to calculate differences in LV functional parameters. Repeated measurements were performed to determine intra-observer and inter-observer variability. (Semi-)automatic measurements revealed a good correlation with manually adjusted measurements for Vitrea (LVEF r = 0.93, EDV r = 0.94, ESV r = 0.98 and MM r = 0.94) and Aquarius (LVEF r = 0.96, EDV r = 0.94, ESV r = 0.98 and MM r = 0.96). Also, good correlation was obtained for Circulation, except for LVEF (LVEF r = 0.45, EDV r = 0.93, ESV r = 0.92 and MM r = 0.86). However, statistically significant differences were found between (semi-)automatically and manually adjusted measurements for LVEF (P < 0.05) and ESV (P < 0.001) in Vitrea, all LV functional parameters in Circulation (P < 0.001) and EDV, ESV and MM (<0.001) in Aquarius Workstation. (Semi-)automatic measurement of LV functional parameters is feasible, but significant differences were found for at least two different functional parameters in all three workstations. Therefore, expert manual correction is recommended at all times.

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Einsatz der Mehrschicht-Spiral-CT beim traumatologischen Notfall und ihre Auswirkungen auf den Untersuchungs- und Behandlungsalgorithmus

Cited by 54 publications

References 11 publications

Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

Schockraumversorgung von schwer verletzten Patienten

Comparison of (semi-)automatic and manually adjusted measurements of left ventricular function in dual source computed tomography using three different software tools

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