Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients

Reitano, Elisa; Granieri, Stefano; Sammartano, Fabrizio; Cimbanassi, Stefania; Galati, Miriam; Gupta, Shailvi; Vanzulli, Angelo; Chiara, Osvaldo

doi:10.1007/s13304-021-01199-w

Cited by 3 publications

(3 citation statements)

References 49 publications

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“…Levy et al [ 67 ] proposed a study about the qualitative and quantitative assessment of abdominal trauma in unstable patients who would not undergo CT scans [ 67 ]. As known, FAST-US evaluates the presence of fluid in the right upper quadrant and the left upper quadrant and in pelvis [ 9 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

“…Focused Assessment with Sonography in Trauma UltraSound (FAST-US) is the first-level exam for traumatized patients, and, whether associated with chest X-ray or pelvis X-ray, FAST-US has a sensitivity and specificity of 90% and 93%, respectively, to identify major injuries in patients who experienced trauma [ 9 , 10 , 11 ]. Although the latest evidence about FAST-US is comforting, the choice of avoiding Contrast-Enhanced Computed Tomography (CE-CT) as a screening exam in an emergency is still controversial [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma

Brunese,

Avella,

Cappuccio

et al. 2024

JPM

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Background: Acute liver injury occurs most frequently due to trauma, but it can also occur because of sepsis or drug-induced injury. This review aims to analyze artificial intelligence (AI)’s ability to detect and quantify liver injured areas in adults and pediatric patients. Methods: A literature analysis was performed on the PubMed Dataset. We selected original articles published from 2018 to 2023 and cohorts with ≥10 adults or pediatric patients. Results: Six studies counting 564 patients were collected, including 170 (30%) children and 394 adults. Four (66%) articles reported AI application after liver trauma, one (17%) after sepsis, and one (17%) due to chemotherapy. In five (83%) studies, Computed Tomography was performed, while in one (17%), FAST-UltraSound was performed. The studies reported a high diagnostic performance; in particular, three studies reported a specificity rate > 80%. Conclusions: Radiomics models seem reliable and applicable to clinical practice in patients affected by acute liver injury. Further studies are required to achieve larger validation cohorts.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma

Brunese,

Avella,

Cappuccio

et al. 2024

JPM

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“…Indiscriminate use of WBCT in these patients could lead to a significant “over-scanning”. Emergency room tests and 6–8 h of observation, followed by a careful re-evaluation, can select patients who need WBCT and discharge those with no injuries [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Structured approach with primary and secondary survey for major trauma care: an overview of reviews

et al. 2023

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Background A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma. Methods We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30–0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence). Conclusions The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.

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No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey

Suda,

Pepke,

Obertacke

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Whole-body computer tomographic examinations (WBCT) are essential in diagnosing the severely injured. The structured clinical evaluation in the emergency trauma room, according to ATLS® and guidelines, helps to indicate the correct radiological imaging to avoid overtriage and undertriage. This retrospective, single-center study aimed to evaluate the value of WBCT in patients with an inconspicuous primary survey and whether there is any evidence for this investigation in this group of patients. Methods This retrospective, single-center study was conducted with patients admitted to a maximum-care hospital and supraregional trauma center in Germany and part of the TraumaNetwork DGU® in southwest Germany between January 2012 and November 2017. Hospital files were used for evaluation, and WBCT was carried out using a 32-row MSCT device from Siemens Healthineers, Volume Zoom, Erlangen, Germany. For evaluation, non-parametric procedures such as the chi-square test, U test, Fisher test, and Wilcoxon rank sum test were used to test for significance (p < 0.05). Results From 3976 patients treated with WBCT, 120 patients (3.02%) showed an inconspicuous primary survey. This examination did not reveal any trauma sequelae in any of this group. Additionally, 198 patients (4.98%) showed minor clinical symptoms in the primary survey, but no morphological trauma sequence could be diagnosed in WBCT diagnostics. Three hundred forty-two patients were not admitted as inpatients after WBCT and discharged to further outpatient treatment because there were no objectifiable reasons for inpatient treatment. Four hundred fifteen patients did not receive WBCT for, e.g., isolated extremity trauma, child, pregnancy, or death. Conclusion Not one of the clinically asymptomatic patients had an imageable injury after WBCT diagnostics in this study. WBCT should only be performed in severely injured patients after clinical assessment regardless of “trauma mechanism.” According to guidelines and ATLS®, the clinical examination seems to be a safe and reliable method for reasonable and responsible decision-making regarding the realization of WBCT with all well-known risk factors.

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Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients

Cited by 3 publications

References 49 publications

Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma

Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma

Structured approach with primary and secondary survey for major trauma care: an overview of reviews

No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey

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