Four years of experience as a major trauma centre results in no improvement in patient selection for whole-body CT scans following blunt trauma

Beak, Philip; Gabbott, Ben; Williamson, Michael; Hing, Caroline B.

doi:10.1007/s00590-019-02592-3

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…The choice is simpler when there is a combination of compromised vital parameters, severe trauma mechanisms and clinical examination findings in keeping with severe injuries [ 12 ]. More difficult, though, is the decision to perform a CT after high energy impact when physical examination is normal [ 14 , 15 ]. Debate continues about the risk-benefit ratio of systematic WBCT when no injuries are clinically suspected.…”

Section: Indicationsmentioning

confidence: 99%

“…The improvement in speed and accuracy of multidetector CT (MDCT) and increased availability of CT scanners in or near the trauma room have made immediate total-body CT feasible as a diagnostic tool in the initial assessment of trauma patients in several institutions, thus reducing time to reaching a diagnosis in life-threatening injuries [ 14 , 18 , 19 , 20 , 29 ]. Furthermore, in institutions where CT scanners have been introduced in trauma resuscitation rooms, a reduction in patient transportation time for CT examination was observed with ultimate reduction in time to control bleeding and a total decrease in mortality from exsanguination [ 12 , 30 , 31 , 32 , 33 ].…”

Section: Timing Of Ctmentioning

confidence: 99%

“…Pulmonary and intra-abdominal parenchymal injuries are exhaustively identified and graded using contrast enhanced CT [ 14 ]. A detailed grading system helps in patient risk stratification and proper management; preferably non-operative.…”

Section: Thoraco-abdominal Parenchymal Injuriesmentioning

confidence: 99%

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Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Iacobellis

Abu-Omar

Crivelli

et al. 2022

IJERPH

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In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist’s expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries.

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Section: Indicationsmentioning

confidence: 99%

Section: Timing Of Ctmentioning

confidence: 99%

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Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Iacobellis

Abu-Omar

Crivelli

et al. 2022

IJERPH

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show abstract

“…On the other hand, a meta-analysis of the diagnostic accuracy of history and physical examination in blunt thoracolumbar-spine trauma evaluation after injury found mechanism, physical examination, and associated injuries together were not accurate predictors of thoracolumbar spine fracture. 35…”

Section: Computed Tomography For Initial Imaging In Major Traumamentioning

confidence: 99%

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

et al. 2020

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Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient’s best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

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The association of hand and wrist injuries with other injuries in multiple trauma patients. A retrospective study in a UK Major Trauma Centre

Tsinaslanidis

Smith

Brown

et al. 2021

Injury

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Four years of experience as a major trauma centre results in no improvement in patient selection for whole-body CT scans following blunt trauma

Cited by 5 publications

References 16 publications

Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

The association of hand and wrist injuries with other injuries in multiple trauma patients. A retrospective study in a UK Major Trauma Centre

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