No abstract

The aim of this study was to develop a standardized non-helical-CT protocol including head, body and proximal extremities in order to achieve a good time efficiency and diagnostic accuracy in the initial radiological evaluation of the multitraumatized patient. A total of 111 circulatory stable blunt trauma patients, brought in to a trauma level II-III hospital, were examined according to a standardized CT protocol. After examining the head with contiguous 10-mm slices without i.v. contrast medium injection, the trunk was examined with 10-mm slices every 30 mm through thorax-abdomen-pelvis with i.v. contrast medium enhancement (occasionally modified). All data in the medical reports were collected and used as "end-point", and the outcome of the CT examination was compared with this final diagnosis. Mean examination time was 20 min (range 12-32 min). In total, 55 head injuries, 89 thoracic injuries, 27 abdominal/pelvic injuries and 62 fractures were found. Computed tomography correctly identified the injuries, except one brain stem injury, one contusion/rupture of the heart, one hepatic injury, two intestinal injuries, eight vertebral injuries and one joint dislocation. A standardized non-helical-CT examination of the head and body may be achieved in 20 min. Its diagnostic accuracy was high, except for vertebral column injuries, which is why we recommend it as the method of choice for initial radiological examination of multitraumatized patients. When available, helical scanning would improve both examination speed and accuracy.

The authors present the potential of using a preset CT protocol covering the whole body of the patient who has suffered blunt trauma to screen for injuries, based on a review of the literature and on 4 years' direct experience. Standardized whole-body CT is the fastest method of examining the whole body, capable of detecting a wide variety of traumatic lesions with a high sensitivity and specificity. Multidetector CT allows a full-body examination to be completed within 5 min, thus minimizing time to diagnosis and the institution of definitive clinical care. Current imaging algorithms that include abdominal ultrasonography and plain radiographic studies need to be reassessed in view of the technical advances in CT diagnosis, but should ultimately depend on the particular imaging capabilities and experience of a given trauma center.