Multislice-Spiral-CT zur Diagnostik beim Polytrauma

Prokop, Aram; Hötte, H.; Krüger, Karsten; Rehm, K. E.; Isenberg, J.; Schiffer, Gereon

doi:10.1007/s00113-006-1086-5

Cited by 38 publications

(19 citation statements)

References 20 publications

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“…The increasing use of computed tomography in our collective, where over 80% of the patients received MSCT in 2007, is in correspondence with recent publications that suggest the use of MSCT in all patients with suspected multiple injuries [12][13][14]. In Germany, the number of trauma centers using whole-body CT for the early assessment of primary trauma is increasing [15,16].…”

Section: Discussionsupporting

confidence: 48%

“…The advantage of including all patients is to haveeven with a high number of residents of all disciplines -a regularly performed algorithm of trauma care, helping to improve care in particular in very difficult cases. The results of other publications correspond to this where time intervals could be significantly improved by the implementation of structured trauma and quality management [12,18,21]. The American College of Surgeons suggest that level I trauma centers should treat at least 1,200 admission or 240 major trauma patients per year with an average of 35 major trauma patients per surgeon [6].…”

Section: Discussionmentioning

confidence: 85%

“…One important aspect of early trauma care known to be closely correlated with survival is time [12,[17][18][19]. In this context, we believe that our time intervals correspond to current quality management criteria, e.g., the completion of an MSCT within 25 ± 12 min or the completion of the secondary survey within 41 ± 23 min.…”

Section: Discussionmentioning

confidence: 99%

“…While the 'golden hour of shock,' as described by Cowley et al [20], elapses during the preclinical phase (80 ± 119 min), in our collective, it becomes even more important to optimize clinical timelines. Computed tomography, e.g., in cases of suspected severe head injury, should be completed within 30 min after admission and other publications report similar time intervals for level I trauma centers in smaller study collectives [12,18]. When compared with data from the Trauma Registry of the German Trauma Society for 2007, our time intervals are superior for ultrasound (3 vs. 6 min), chest X-ray (7 vs. 11 min), and pelvic X-ray (8 vs. 14 min), and comparable for MSCT (25 vs. 24 min) [8].…”

Section: Discussionmentioning

confidence: 99%

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Five years experience of trauma care in a German urban level I university trauma center

Wyen

Wutzler

Rüsseler

et al. 2009

Eur J Trauma Emerg Surg

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Five years experience of trauma care in a German urban level I university trauma center

Wyen

Wutzler

Rüsseler

et al. 2009

Eur J Trauma Emerg Surg

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“…Another key factor is the time required for radiologic examination, which, because the chance of survival increases the sooner trauma care is initiated, must be as short as possible [1,3]. The reliability and workflow of MDCT for emergency purposes have been supported by the results of several studies [3][4][5][6][7]. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions.…”

Section: Cmementioning

confidence: 99%

Evaluation of a Single-Pass Continuous Whole-Body 16-MDCT Protocol for Patients with Polytrauma

Nguyên

Platon

Shanmuganathan

et al. 2009

American Journal of Roentgenology

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examinations most often include the head, cervical spine, and thorax to pelvis. Although MDCT data acquisition time is no longer a cause of time delays, the need to reposition patients for conventional protocols can be time consuming [5,7]. Gralla et al. [5] reported the results of a prospective study in which 497 patients underwent whole-body CT. The mean repositioning time was 8 minutes, accounting for up to 26% of the total time in the CT room.The aim of our prospective study was to compare the acquisition times and image quality of two single-pass continuous wholebody MDCT protocols with those of our conventional segmental whole-body MDCT protocol. Two single-pass protocols with various injection flow rates and iodine concentrations were evaluated. S p e c i a l A r t ic l e • O r ig i n a l R e s e a rc h CMEThis article is available for CME credit. See www.arrs.org for more information. CT assessment of such patients should be systematic, complete, and accurate. Another key factor is the time required for radiologic examination, which, because the chance of survival increases the sooner trauma care is initiated, must be as short as possible [1,3]. The reliability and workflow of MDCT for emergency purposes have been supported by the results of several studies [3][4][5][6][7]. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such OBJECTIVE. The purpose of this study was to compare a conventional multiregional MDCT protocol with two continuous single-pass whole-body MDCT protocols in imaging of patients with polytrauma. SUBJECTS AND METHODS.Ninety patients with polytrauma underwent wholebody 16-MDCT with a conventional (n = 30) or one of two single-pass (n = 60) protocols. The conventional protocol included unenhanced scans of the head and cervical spine and contrastenhanced helical scans (140 mL, 4 mL/s, 300 mg I/mL) of the thorax and abdomen. The single-pass protocols consisted of unenhanced scans of the head followed by one-sweep acquisition from the circle of Willis through the pubic symphysis with a biphasic (150 mL, 6 and 4 mL/s, 300 mg I/mL) or monophasic (110 mL, 4 mL/s, 400 mg I/mL) injection. Acquisition times and interval delays between head, chest, and abdominal scans were recorded. Contrast enhancement was measured in the aortic arch, liver, spleen, and kidney. Diagnostic image quality in the same areas was assessed on a 4-point scale.RESULTS. Median acquisition times for the single-pass protocols were significantly shorter (-42.5%) than the acquisition time for the conventional protocol. No significant differences were found in mean enhancement values in the aorta, liver, spleen, and kidney for the three protocols. The image quality with both single-pass protocols was better than that with the conventional protocol in assessment of the mediastinum and cervical spine (p < 0.05). There was no significant difference between the single-pass protocols.CONCLUSION. Us...

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Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients

Sierink¹,

Saltzherr²,

Reitsma

et al. 2011

British Journal of Surgery

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Background:The aim of this review was to assess the value of immediate total-body computed tomography (CT) during the primary survey of injured patients compared with conventional radiographic imaging supplemented with selective CT.Methods: A systematic search of the literature was performed in MEDLINE, Embase, Web of Science and Cochrane Library databases. Reports were eligible if they contained original data comparing immediate total-body CT with conventional imaging supplemented with selective CT in injured patients. The main outcomes of interest were overall mortality and time in the emergency room (ER).Results: Four studies were included describing a total of 5470 patients; one study provided 4621 patients (84·5 per cent). All four studies were non-randomized cohort studies with retrospective data collection. Mortality was reported in three studies. Absolute mortality rates differed substantially between studies, but within studies mortality rates were comparable between immediate total-body CT and conventional imaging strategies (pooled odds ratio 0·91, 95 per cent confidence interval 0·79 to 1·05). Time in the ER was described in three studies, and in two was significantly shorter in patients who underwent immediate total-body CT: 70 versus 104 min (P = 0·025) and 47 versus 82 min (P < 0·001) respectively. Conclusion:This review showed differences in time in the ER in favour of immediate total-body CT during the primary trauma survey compared with conventional radiographic imaging supplemented with selective CT. There were no differences in mortality. The substantial reduction in time in the ER is a promising feature of immediate total-body CT but well designed and larger randomized studies are needed to see how this will translate into clinical outcomes.

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Multislice-Spiral-CT zur Diagnostik beim Polytrauma

Abstract: The shorter the time spent in the ED, the shorter the stays in ICU and in total hospitalization were, regardless of injury severity. With structured management and shortening of diagnostic time with spiral CT, the time in the ED was decreased from 85 to 48 min.

Cited by 38 publications

References 20 publications

Five years experience of trauma care in a German urban level I university trauma center

Five years experience of trauma care in a German urban level I university trauma center

Evaluation of a Single-Pass Continuous Whole-Body 16-MDCT Protocol for Patients with Polytrauma

Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients

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