European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)

Abstract

Background Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. Results Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org) and a short version also covering all recommendations (this article). Conclusions Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.

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

“…Even if it has been proven that the maintenance of a standard protocol for whole-body CT after polytrauma increases the probability of survival, there is the impression that the number of patients with minor injuries who undergo WBCT has increased [ 44 ]. In an attempt to limit the excessive dose exposure, the European Society of Emergency Radiology (ESER), made a recent proposal to consider at least two different WBCT protocols: the Time/Precision Protocol (multiphasic CT study) that should be preferred for polytrauma patients with life-threatening injuries or hemodynamically unstable conditions, and the Dose Protocol (split bolus) which is preferred for polytrauma patients who do not have obvious life-threatening injuries or are hemodynamically unstable [ 11 , 44 ].…”

Stumpfe cerebrovaskuläre Verletzungen – Terminierung von Kontrolluntersuchungen

“…Die Ganzkörper CT hat nachweislich einen positiven Einfluss auf das Gesamtsurvival in einer Traumapopulation und senkt die Mortalität, so die Daten einer deutschen Arbeitsgruppe aus Radiologen und Unfallchirurgen [2]. Zuletzt entstand 2020 dazu eine erste europäische Polytrauma Guideline der ESER (European Society of Emergency Radiology), die den evidenzbasierten Wissensstand für die Radiologie erstmals zusammenfasst [3].…”

“…Die Empfehlung zum radiologischen Follow-up betrifft das Zeitfenster zwischen 30 und 90 Tagen, danach werden keine klinisch maßgeblichen Änderungen mehr apparent. Eine lange bestehende diagnostische Lücke wurde mit der Einführung der Ganzkörper CT [3] geschlossen, die heute immer als CT die supraaortalen Gefässe bis zum C. willisii einschließt.…”

Structured Reporting of Whole-Body Trauma CT Scans Using Checklists: Diagnostic Accuracy of Reporting Radiologists Depending on Their Level of Experience

“…Insbesondere bei schwerverletzten Patienten kann die Durchführung einer Ganzkörper-CT zu diesem frühen Zeitpunkt dazu beitragen, die Mortalität signifikant zu senken [6]. Durch die Notwendigkeit einer umgehenden Detektion lebensbedrohlicher Verletzungsmuster ist eine zuverlässige und belastbare radiologische Befundung unerlässlich.…”