Whole‐body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection?

Abstract

The decision to perform WBCT scans in trauma should be at the discretion of the treating clinician. Applying a prediction rule would increase the number of WBCT scans performed without improving overall accuracy.

Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims

“…Patient selection for the examination can be made based on indicators such as clinical evidence of multi-area injury, mechanism, and abnormal physiological parameters. 9 There is a wide variation in opinion amongst authors regarding the indication for WBCT. In a study by Salim et al 21 of 592 trauma patients with no clinical evidence of injury, occult injuries that led to a change in clinical management were identified in 18.9% of patients at WBCT, leading the authors to conclude that liberal use of WBCT is indicated in patients with suspected blunt multi-system trauma.…”

“…20 Asha et al 10 found that a mandatory WBCT protocol led to a significant increase in radiation exposure. Hsiao et al 9 concluded that a prediction model for using WBCT did not significantly alter clinical accuracy and advocated using a thorough clinical assessment by the emergency physician as the most appropriate method to decide on the indication for WBCT. 9 In our centre a combination of factors is used to decide on the indication for WBCT, as it is known that any one factor in isolation has a poor specificity for severe injury.…”

“…Hsiao et al 9 concluded that a prediction model for using WBCT did not significantly alter clinical accuracy and advocated using a thorough clinical assessment by the emergency physician as the most appropriate method to decide on the indication for WBCT. 9 In our centre a combination of factors is used to decide on the indication for WBCT, as it is known that any one factor in isolation has a poor specificity for severe injury. 11,24 The presence of a significant mechanism of injury, clinical evidence or significant suspicion of injury to two or more body areas, and haemodynamic instability are all key indicators for WBCT (Fig 1).…”

“…8 Prediction models using a combination of mechanism, physiological parameters, the presence of the trauma team and patient demographics have also not proved accurate. 9 This has led some authors to conclude that the decision to choose WBCT should be left to the discretion of the attending emergency physician. 9 Based on this rationale, the trauma team leader, who is usually an experienced emergency department physician, has the final decision on whether a patient undergoes WBCT, which confers one of the highest radiation dose examinations carried out in the radiology department.…”

“…9 This has led some authors to conclude that the decision to choose WBCT should be left to the discretion of the attending emergency physician. 9 Based on this rationale, the trauma team leader, who is usually an experienced emergency department physician, has the final decision on whether a patient undergoes WBCT, which confers one of the highest radiation dose examinations carried out in the radiology department. Given that the routine use of trauma WBCT has led to increased radiation doses in a population skewed towards younger age groups, the appropriate use of this high-dose examination clearly needs to be monitored.…”