Trauma surgeon utilization of computerized tomography scanning: Room for improvement?

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 …”

“…This is an exploratory analysis. Previous research from higher risk cohorts suggests that up to 89% of WBCT had zero or one significant findings . We hypothesised that our rate of defined serious injury would be <10%.…”

“…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.…”

“…Definitions of serious injury were based on those used by Ong et al . and included: Brain: intracranial haemorrhage or contusion, skull fracture, pneumocephalus and ocular haemorrhage/globe injury. Cervical spine: fracture, acute subluxation or dislocation. Chest: greater than two rib fractures or flail segment, displaced sternal fracture, haemothorax requiring intervention, pneumothorax requiring intervention, injury to heart or great vessels, mediastinal haemorrhage, chest wall contusion with contrast extravasation, spinal fracture, intraparenchymal lung haemorrhage or clinically significant contusion (hypoxia, ventilation, length of stay >2 days). Abdomen/pelvis: solid organ injuries, suspected hollow viscus injury, intra‐abdominal or retroperitoneal haemorrhage, fracture of the spine or pelvis/acetabulum (excluding femoral and undisplaced pubic rami fractures) and abdominal wall contusion with contrast extravasation. …”

“…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 …”