Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

Abstract

BackgroundWhole-body multislice computed tomography (WB-MSCT) has become an important diagnostic tool in the early treatment phase of severely injured patients. The optimal moment of WB-MSCT’s use during this treatment phase remains unclear. Many trauma centers use WB-MSCT in addition to conventional radiographs, while some trauma centers use WB-MSCT as the only radiological tool. The aim of this study was to determine the differences between these two protocols and to answer the question of whether conventional radiographs can still be used in the safe treatment of polytrauma patients.MethodsPatients from the TraumaRegister DGU® with an injury severity score (ISS) of ≥16 were included. Group I received conventional radiographs and focused assessment with sonography in trauma (FAST) prior to a WB-MSCT, and group II received an initial WB-MSCT and FAST. Both groups were compared concerning treatment time and outcome.ResultsA total of 3,995 patients in group I were compared to 4,025 patients in group II. There were no differences in ISS (29.97 vs. 29.94), gender (male: 73.5% vs. 72.8%), age (45.47 vs. 45.12 years), or calculated mortality (21.41% vs. 21.44%). Time needed in the resuscitation room was slightly longer in group I (72 vs. 64 min); the durations until admittance to the ICU and arrival to the OR were not significantly different between the groups. There was no difference in mortality (18.2% vs. 18.4%) or the standardized mortality ratio (SMR) (0.85 vs. 0.86).ConclusionsWB-MSCT plays an inherent role in the treatment of multiple-injured patients. However, the use of WB-MSCT as the only diagnostic method in the resuscitation room is not needed. Conventional radiographs and FAST followed by WB-MSCT can be performed in the early resuscitation phase without impairing patient outcomes. This approach enables the emergency room team to perform life-saving procedures - chest-tube insertion, laparotomy, cardiopulmonary resuscitation -immediately and simultaneous. Nevertheless, randomized multi-center trials are needed to determine the comparability and effectiveness of these algorithms.

Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients?

“…Our study also demonstrated that CT panscans did not improve TTS or decrease LOS in the fragility fracture patient population, which directly contradicts the patterns seen in younger patient populations. 14,17 Our results support previous studies that have shown CT pan-scans in the elderly population have demonstrated a significant risk of incidental findings. The rate of unrelated findings in CT whole-body imaging has been reported as high as 50% and is known to be directly related to increasing age.…”

“…12,16 Several studies have shown some benefit, such as preventing under triage, decreased time to diagnosis, and improved diagnostic accuracy. 3,17,20,21 However, these studies address the general trauma population or any trauma occurring in the geriatric population. To our knowledge, no study has directly addressed orthopedic management in patients who have sustained fragility fractures and are subject to this diagnostic strategy.…”

The role of whole-body computed tomography in the diagnosis of thoracic injuries in severely injured patients – a retrospective multi-centre study based on the trauma registry of the German trauma society (TraumaRegister DGU®)

“…In recent years, a trauma room algorithm has become widely accepted in Germany which is based on Advanced Trauma Life Support (ATLS ® ) and the European Trauma Course [ 3 – 5 ]. Nevertheless, the imaging technique to be used in the trauma room setting continues to be a matter of debate on account of time constraints, the level of radiation exposure, the patient’s overall condition, and other factors [ 6 – 8 ]. Computed tomography (CT), and in particular modern multi-slice computed tomography (MSCT), has become the standard imaging modality for diagnosing thoracic injuries [ 6 – 8 ].…”

Clinical guided computer tomography decisions are advocated in potentially severely injured trauma patients: a one-year audit in a level 1 trauma Centre with long pre-hospital times

“…In the latter, the pre-test likelihood of an unsuspected injury is high implying that widespread use of immediate SWBCT may be justified. Interestingly, two different analyses of patients included in the TraumaRegister DGU® of the German trauma society concluded conflictingly with regard to the potential survival benefit of immediate SWBCT [16,18,69].…”