Caring for the major trauma victim: the role for radiology.

Abstract

Two innovations have improved the care of the major trauma victim in the past 20 years. Both depend on active radiologist participation. The first has been the progressive nationwide development of the Emergency Medical Service System, which identifies trauma centers by a process of categorization, regionalization, and verification. The hospital must be staffed and equipped to perform computed tomography, angiography, and sonography. Trauma centers effectively reduce morbidity and mortality of the accident patient. The second innovation has been the intensive use of computed tomography (CT) for immediate patient evaluation. CT surpasses other imaging methods in examination for craniocerebral, abdominal, spinal, pelvic, and facial trauma. In craniocerebral trauma, the precise diagnosis afforded by CT reduces the fatality rate by permitting early surgical intervention. In abdominal trauma, CT examination supports nonoperative management of hemodynamically stable patients with solid organ injury. In spinal, pelvic, and facial injuries, CT provides diagnostic information not available with conventional radiography.

Computed Tomography: Revolutionizing the Practice of Medicine for 40 Years

“…In his 1986 presidential address to mark the Radiological Socirty of North America's 71st year, James McCort focused on the profound effect of CT in the transformation of care for patients with major trauma, citing the concurrent development and resulting synergies of a formalized system of legislated trauma centers and CT scanning as critical to substantial improvements in survival (171).…”

“…Before leaving the topic of trauma, the effect of CT on the assessment of skeletal injuries, particularly pelvic and spinal injuries, should be noted because CT replaced countless series of pelvic and spinal radiographs that resulted in failure to diagnose subtle fractures, characterize skeletal displacement, and detect intraarticular and intracanalicular bone fragments (171) and because CT brought greater safety, sensitivity, and cost-effectiveness to the diagnosis of cervical spinal injury (199).…”

Blunt upper abdominal trauma: evaluation by CT.

“…Two important advances in the treatquential from significant bleeding [2,13], resulting in unnecment of trauma patients in the past decade have been the essary laparotomies in 6-25% of cases [6,7,14]. DPL also and pelvic fractures can result in false-positive examinations tality rates [2]. CT has become an integral part of the clinical [7,15].…”

Characterization of indeterminate spleen lesions in primary CT after blunt abdominal trauma: potential role of MR imaging

“…The accuracy of contrast-enhanced CT for the evaluation of traumatic visceral injury is well established with reported sensitivities and specificities ranging from 93 to 96 % [13,14]. Portal-venous phase CT imaging is considered the standard for evaluating patients after abdominal trauma [15].…”