Indications for total-body computed tomography in blunt trauma patients: a systematic review

Treskes, Kaij; Saltzherr, Teun Peter; Luitse, Jan S. K.; Beenen, Ludo F. M.; Goslings, J. C.

doi:10.1007/s00068-016-0711-4

Cited by 28 publications

(23 citation statements)

References 32 publications

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“…Compromised vital parameters, clinical suspicion of severe injuries, and high-risk mechanisms are widely used as criteria for TBCT in severe trauma [5,6]. The first report by Wurmb et al on such a set of criteria for iTBCT described a PPV of 69% and sensitivity of 97% for ISS ≥ 16 in sedated and ventilated severe trauma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the potentially increased radiation exposure by this diagnostic approach, proper selection of severely injured patients is mandatory [2][3][4]. Criteria for total-body CT in trauma vary across trauma centers and consensus is lacking [5,6]. Early identification of severely injured patients will reduce exposure to radiation by iTBCT in less severely injured patients.…”

Section: Introductionmentioning

confidence: 99%

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Refining the criteria for immediate total-body CT after severe trauma

et al. 2020

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Objectives Initial trauma care could potentially be improved when conventional imaging and selective CT scanning is omitted and replaced by immediate total-body CT (iTBCT) scanning. Because of the potentially increased radiation exposure by this diagnostic approach, proper selection of the severely injured patients is mandatory. Methods In the REACT-2 trial, severe trauma patients were randomized to iTBCT or conventional imaging and selective CT based on predefined criteria regarding compromised vital parameters, clinical suspicion of severe injuries, or high-risk trauma mechanisms in five trauma centers. By logistic regression analysis with backward selection on the 15 study inclusion criteria, a revised set of criteria was derived and subsequently tested for prediction of severe injury and shifts in radiation exposure. Results In total, 1083 patients were enrolled with median ISS of 20 (IQR 9-29) and median GCS of 13 (IQR 3-15). Backward logistic regression resulted in a revised set consisting of nine original and one adjusted criteria. Positive predictive value improved from 76% (95% CI 74-79%) to 82% (95% CI 80-85%). Sensitivity decreased by 9% (95% CI 7-11%). The area under the receiver operating characteristics curve remained equal and was 0.80 (95% CI 0.77-0.83), original set 0.80 (95% CI 0.77-0.83). The revised set retains 8.78 mSv (95% CI 6.01-11.56) for 36% of the non-severely injured patients. Conclusions Selection criteria for iTBCT can be reduced from 15 to 10 clinically criteria. This improves the positive predictive value for severe injury and reduces radiation exposure for less severely injured patients. Key Points • Selection criteria for iTBCT can be reduced to 10 clinically useful criteria.• This reduces radiation exposure in 36% of less severely injured patients.• Overall discriminative capacity for selection of severely injured patients remained equal.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Refining the criteria for immediate total-body CT after severe trauma

et al. 2020

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“…There are no standardised and universally approved criteria for qualifying patients for WBCT in trauma cen-tres. They may vary not only between countries but even between individual centres [2]. In general, these criteria are based on an assessment of the vital signs of the patient and the mechanism of trauma suggesting its high-energy nature, and they sometimes also include an element of clinical judgement raising the suspicion of a serious injury.…”

Section: Introductionmentioning

confidence: 99%

Rationality of using whole-body computed tomography in trauma patients

2020

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Purpose: Identification of the group of patients meeting the criteria of a severe multiple trauma (polytrauma) among those admitted to the regional trauma centre and subjected to whole-body computed tomography (WBCT) due to injuries. Identification the patients for whom WBCT was the optimal choice. Material and methods: Retrospective analysis of the data of 303 patients undergoing WBCT in the period 2015-2017 with assessment of the injury severity based on the abbreviated injury scale (AIS) and injury severity score (ISS). Results: Among 303 patients undergoing WBCT due to trauma, multiple injuries with ISS > 15 were found in 74 individuals (24.4%). After excluding patients whose limb fractures increased ISS above 15, the group decreased to 63 patients (20.8%). For these patients, the WBCT may be described as the optimal imaging method at an early stage of management. Conclusions: Trauma patients are too often qualified for WBCT. Exposure to a high dose of ionising radiation associated with this modality requires critical analysis of the scope of indications and rules of conduct for trauma teams.

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“…The use of either torso CT or a "pan CT," which includes CT of the head, cervical spine, chest, abdomen, and pelvis, has been shown to be beneficial in severely injured patients that do not have a reliable physical exam [5,[15][16][17]. However, even in evaluable patients, the sensitivity of physical examination and plain radiographs remain deadened to detecting some injuries, and there is controversy with regard to selecting the appropriate patients to undergo torso CT [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

et al. 2020

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Background: High morbidity and mortality rates of trauma injuries make early detection and correct diagnosis crucial for increasing patient's survival and quality of life after an injury. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). However, the increased use of CT imaging is not universally advocated for. Some advocate for the use of selective CT imaging, especially in cases where the severity of the injury is low. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. Methods: A retrospective review of non-intubated, adult blunt trauma patients with an initial GCS of 14 or 15 evaluated in an ACS verified level 1 trauma center from July 2012 to June 2015 was performed. Data was obtained from the hospital's trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. The statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. Results: There were 2306 patients included in this study, with a mean ISS of 8. For patients with a normal chest exam that had a chest CT, 15% were found to have an occult chest injury. In patients with a negative chest exam and negative chest X-ray, 35% had occult injuries detected on chest CT. For patients with a negative abdominal exam and CT abdomen and pelvis, 16% were found to have an occult injury on CT. Lastly, 25% of patients with normal chest, abdomen, and pelvis exams with chest, abdomen, and pelvis CT scans demonstrated occult injuries. Asymptomatic patients with a negative CT had a length of stay 1 day less than patients without a corresponding CT. No incidents of contrast-induced complications were recorded. Conclusions: A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay.

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Indications for total-body computed tomography in blunt trauma patients: a systematic review

Cited by 28 publications

References 32 publications

Refining the criteria for immediate total-body CT after severe trauma

Refining the criteria for immediate total-body CT after severe trauma

Rationality of using whole-body computed tomography in trauma patients

Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

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