Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

Abstract

Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient’s best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

“…In-house imaging would prevent these scenarios. Exclusive access to imaging and radiology teams would also allow for bedside imaging, so that patients would not leave the unit or nurses’ observation, a critical factor during MCIs, as patients in this case may be highly unstable and so require continuous supervision (Qamar et al, 2020). Gil et al (2020) found that locating a dedicated MRI scanner in ED enables faster hip fracture diagnosis and surgical consultation without also increasing ED throughput time.…”

Minör Travma Hastalarının Yönetiminde Tüm Vücut Bilgisayarlı Tomografinin Rolünün Değerlendirilmesi

“…On the other hand, some authors in their well written review pointed out that diagnosing occult injuries with routine WBCT allows of safe and fast disposition from ED and obviates requiring of subsequent imaging and medical evaluation when patients present for follow-up with nonspecific pain or other complaints. [18] And, rightly again, they concluded that even some minor injuries, that may be misdiagnosed when WBCT wasn't used, can be fatal in the special population.…”

Importance of the Mechanism of Injury in Trauma Radiology Decision-Making

“…Bedside imaging has an important role in the urgent management of patients with severe trauma. Chest radiography in patients with respiratory distress and pelvic radiography in patients with suspected pelvic fractures assist in initiating rapid stabilization procedures prior to computed tomography (CT) [ 16 ]. However, routine radiography and focused abdominal sonography in trauma (FAST) in stable patients should not delay transfer once a decision to perform CT has been made [ 17 ].…”