Pan computed tomography for blunt polytrauma: Are we doing too many?

Oosthuizen, George; Bruce, John; Bekker, W; Shangase, N; Laing, G L; Clarke, Damian

doi:10.7196/samj.2016.v106i8.10376

Cited by 8 publications

(16 citation statements)

References 28 publications

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“…Specifically, the range of negative WBCT starts from as low as 7% and goes as high as 57%. 6 , 10 , 12 , 15–18 Locally, only one study done by Orf et al reported the rate of negative WBCT in a single institute in the KSA, which was 30.5%. 19 However, this study included only the victims of MVCs.…”

Section: Discussionmentioning

confidence: 99%

“…WBCT has become the preferred imaging modality due to its rapid and highly sensitive detection of acute traumatic injuries. 5 , 15 Although WBCT demonstrates a benefit in rapid recognition and treatment, it has been shown that only one-fifth (~19%) of the patients’ management was changed by the WBCT findings. 21 On the other hand, another study by Oosthuizen et al has reported 77% of WBCT influenced the course of management in their polytrauma cohort.…”

Section: Discussionmentioning

confidence: 99%

“… 21 On the other hand, another study by Oosthuizen et al has reported 77% of WBCT influenced the course of management in their polytrauma cohort. 15 The main difference between the two studies was the policy of ordering WBCT. The study by Salim et al used a liberal WBCT scanning policy, compared to the study by Oosthuizen et al, which applied a strict protocol for the use of WBCT in their trauma patients to minimize unnecessary scans.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study</p>

Maghraby

Alshaqaq

AlQattan

et al. 2020

OAEM

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Background Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients. Patients and Methods A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients. Results A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans. Conclusion Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study</p>

Maghraby

Alshaqaq

AlQattan

et al. 2020

OAEM

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“…The use of pan CT in trauma for stable, unevaluable adult trauma patients is popular. The role of pan CT in the awake, mildly injured, evaluable patient is less clear and still widely debated [17,20,22]. Similar statements are true for a torso or thoracoabdominal CT [23].…”

Section: Introductionmentioning

confidence: 96%

“…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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The spectrum and outcome of blunt trauma related enteric hollow visceral injury

Bekker

Kong

Laing

et al. 2018

annals

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Introduction This audit focused on patients who sustained enteric injury following blunt abdominal trauma. Methods Our prospectively maintained electronic registry was interrogated retrospectively, and all patients who had sustained blunt abdominal trauma between December 2011 and January 2016 were identified. Results Overall, 2,045 patients had sustained blunt abdominal trauma during the period under review. Seventy per cent were male. The median age was 28 years. Sixty patients (2.9%) sustained a small bowel injury (SBI). Thirty-five of these were peritonitic on presentation. All patients with a SBI had a chest x-ray and free air was present in seven. In 18 patients with a SBI, computed tomography (CT) was performed, which revealed isolated free fluid in 12 and free intraperitoneal air in 5. In five cases, the CT was normal. A total of 32 patients (1.5%) sustained blunt duodenal trauma (BDT). All patients with BDT had a chest x-ray on presentation. Free intraperitoneal air was not present in any. CT was performed on 17 patients with BDT. This revealed isolated free fluid or retroperitoneal air in 12. The median delay between injury and presentation for these enteric injures was 15.5 hours (interquartile range [IQR]: 8-25 hours) while between presentation at hospital and operation, the median delay was 6 hours (IQR: 3-13 hours). Conclusions Blunt trauma related enteric hollow visceral injury remains associated with delayed diagnosis and significant morbidity. It can be caused by a disparate array of mechanisms and is difficult to diagnose even with modern imaging strategies.

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Pan computed tomography for blunt polytrauma: Are we doing too many?

Cited by 8 publications

References 28 publications

<p>Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study</p>

<p>Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study</p>

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

The spectrum and outcome of blunt trauma related enteric hollow visceral injury

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