In major trauma it is essential to immediately recognize and treat life-threatening problems and conditions. Most trauma protocols reserve the use of computed tomography for the secondary survey, as patients cannot be attended to during the examination and must be transferred from the emergency room to the CT suite. The relevant reduction in the scanning time of multidetector computed tomography (MDCT) or multislice computed tomography (MSCT) justifies its use as the major diagnostic adjunct for primary trauma survey and initial resuscitation. According to our ATLS((R))-based trauma algorithm, the multidetector scanner situated in the emergency department is utilized immediately after the correction of respiratory problems to detect causes of bleeding or intracranial hematomas. In a prospective series a total of 125 consecutive major trauma patients were evaluated. After focused sonography in trauma (FAST) and plain chest films in intubated patients, whole body MDCT was performed. By retrieving data from our trauma registry and a picture archiving and communication system (PACS), time from trauma room admission to the end of head CT scan for the entire MDCT study and calculation of multiplanar reconstruction (MPR) was analyzed. Additionally, relevant complications such as untreated tension pneumothorax or circulatory arrest during MDCT examination were recorded. The time from admission to the trauma room until completion of head CT scan without contrast was 21:12 min (median, IQR 18:13-27:52). The entire contrast-enhanced MDCT study, including pilot scan and contrast application, required 6:08 min (median, IQR 4:33-8:14) with a total scanning time of 0:59 min (median, IQR 0:55-1:03). MPR calculation of the spine and bony pelvis was performed in 11:37 min (median, IQR 8:03-16:41). A relevant life-threatening complication due to CT scanning during primary trauma survey was not observed in the 125 cases (0/125 CI 95% 0%-3%). Complete diagnostic imaging can be performed within 30 min after trauma room admission by using MDCT. During the primary survey, treatment of the patient is interrupted just for the few minutes of the CT scan and contrast application. An adequate survey of injuries can be achieved earlier and a targeted therapy can be initiated ahead of time. Integration of MDCT scanners in the primary trauma survey provides a high standard of imaging in a very short time without endangering the patient. When dealing with multiple casualties, MDCT could be used also as an accurate and time-efficient means of hospital triage to diagnose and prioritize patients and to plan further surgical interventions and intensive care.
BackgroundImmediate recognition of life-threatening conditions and injuries is the key to trauma management. To date, the impact of focused assessment with computed tomography in trauma (FACTT) has not been formally assessed. We aimed to find out whether the concept of using FACTT during primary trauma survey has a negative or positive effect on survival.MethodsIn a retrospective, multicentre study, we compared our time management and probability of survival (Ps) in major trauma patients who received FACTT during trauma resuscitation with the trauma registry of the German Trauma Society (DGU). FACTT is defined as whole-body computed tomography (WBCT) during primary trauma survey. We determined the probability of survival according to the Trauma and Injury Severity Score (TRISS), the Revised Injury Severity Classification score (RISC) and the standardized mortality ratio (SMR).ResultsWe analysed 4.817 patients from the DGU database from 2002 until 2004, 160 (3.3%) were from our trauma centre at the Ludwig-Maximilians-University (LMU) and 4.657 (96.7%) from the DGU group. 73.2% were male with a mean age of 42.5 years, a mean ISS of 29.8. 96.2% had suffered from blunt trauma. Time from admission to FAST (focused assessment with sonography for trauma)(4.3 vs. 8.7 min), chest x-ray (8.1 vs. 16.0 min) and whole-body CT (20.7 vs. 36.6 min) was shorter at the LMU compared to the other trauma centres (p < 0.001). SMR calculated by TRISS was 0.74 (CI95% 0.40-1.08) for the LMU (p = 0.24) and 0.92 (CI95% 0.84-1.01) for the DGU group (p = 0.10). RISC methodology revealed a SMR of 0.69 (95%CI 0.47-0.92) for the LMU (p = 0.043) and 1.00 (95%CI 0.94-1.06) for the DGU group (p = 0.88).ConclusionTrauma management incorporating FACTT enhances a rapid response to life-threatening problems and enables a comprehensive assessment of the severity of each relevant injury. Due to its speed and accuracy, FACTT during primary trauma survey supports rapid decision-making and may increase survival.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.