Routine versus selective chest and abdominopelvic CT-scan in conscious blunt trauma patients: a randomized controlled study

Abstract

Routine chest and abdominopelvic CT-scan in conscious blunt trauma patients decreases the hospitalization time, but has no impact on patient outcome and probably might lead to overtreatment of occult injuries. The option of using a selective approach should be further evaluated to decrease radiation exposure and facility overuse.

Yield of serious axial injury from pan scans after blunt trauma in haemodynamically stable low‐risk trauma patients

“…The difference is an estimated excess cancer rate of 0.065% or 6.5/10 000 patients for patients undergoing WBCT compared to selective imaging. Although this may seem a very small number, our data and accumulated research suggests that this additional risk is being carried for no outcome benefit …”

“…Recently, WBCT scans have gained popularity in trauma centres for investigation of patients suffering severe trauma on the rationale that they more quickly and accurately identify injuries and allow earlier intervention if required. Their impact on patient outcome, compared to selective CT scanning, is the subject of some controversy and the risk of adverse events is not negligible. Although the logic underlying this practice might be reasonable for unconscious or critically ill patients, it is more tenuous in conscious or haemodynamically stable patients.…”

“…A recent randomised controlled trial of high‐risk trauma patients failed to show a reduction in mortality between WBCT and standard imaging with selected CT scans for the overall cohort and for the polytrauma and traumatic brain injury subgroups . Recent studies have challenged the role of WBCT in stable patients reporting that a selective approach has similar outcomes …”

“…2 Recent studies have challenged the role of WBCT in stable patients reporting that a selective approach has similar outcomes. [3][4][5] Although WBCT may have a role in unstable or unconscious patients, the yield for significant clinical abnormality and the risk-benefit ratio of WBCT in the lower risk trauma cohort is unclear. The practice of WBCT is probably most contentious in awake, stable patients at low risk of life-threatening injury.…”

Focus on imaging in trauma

“…In conscious and hemodynamically stable blunt trauma patients (mean ISS 8), Moussavi et al [2] prospectively assessed the relevance of performing routine versus selective (i.e., according to clinical presentation) chest and abdominalpelvic CT scan for hospitalization time and outcome after blunt trauma. In this study, a two-to-threefold increase of CT scans after routine CT utilization was observed.…”