Use of a full-body digital X-ray imaging system in acute medical emergencies: a systematic review

Yang, Lei; Ye, Ligang; Ding, Jianbo; Zheng, Zongheng; Zhang, Mao

doi:10.1136/emermed-2014-204270

Cited by 11 publications

(11 citation statements)

References 37 publications

(46 reference statements)

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“…MSCT is performed at our institution for demonstrating the exact fracture extent and for preoperative planning. In a recently published review with 256 included articles, LS demonstrated sensitivities ranging from 62 % to 73 %, and specificities ranging from 99 % to 100 % compared to CT in the evaluation of multiple trauma patients [16]. The authors reported conflicts of interest for several of the included and reviewed studies, giving a potential explanation for the lower diagnostic accuracy observed in our analysis.…”

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confidence: 68%

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Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Jöres

Heverhagen

Bonél

et al. 2015

Fortschr Röntgenstr

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Purpose: The purpose of this study was to evaluate the diagnostic accuracy of full-body linear X-ray scanning (LS) in multiple trauma patients in comparison to 128-multislice computed tomography (MSCT). Materials and Methods: 106 multiple trauma patients (female: 33; male: 73) were retrospectively included in this study. All patients underwent LS of the whole body, including extremities, and MSCT covering the neck, thorax, abdomen, and pelvis. The diagnostic accuracy of LS for the detection of fractures of the truncal skeleton and pneumothoraces was evaluated in comparison to MSCT by two observers in consensus. Extremity fractures detected by LS were documented. Results: The overall sensitivity of LS was 49.2?%, the specificity was 93.3?%, the positive predictive value was 91?%, and the negative predictive value was 57.5?%. The overall sensitivity for vertebral fractures was 16.7?%, and the specificity was 100?%. The sensitivity was 48.7?% and the specificity 98.2?% for all other fractures. Pneumothoraces were detected in 12 patients by CT, but not by LS.?40 extremity fractures were detected by LS, of which 4 fractures were dislocated, and 2 were fully covered by MSCT. Conclusion: The diagnostic accuracy of LS is limited in the evaluation of acute trauma of the truncal skeleton. LS allows fast whole-body X-ray imaging, and may be valuable for detecting extremity fractures in trauma patients in addition to MSCT. Key Points: ??The overall sensitivity of LS for truncal skeleton injuries in multiple-trauma patients was

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confidence: 68%

“…These figures are comparable to that of conventional radiography in emergency settings [16]. The low sensitivity of LS for detecting injuries of the truncal skeleton in multiple-trauma patients limits its application in emergency settings, and leads to the discussion, whether LS can provide adequate diagnostic value.…”

mentioning

confidence: 88%

Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Jöres

Heverhagen

Bonél

et al. 2015

Fortschr Röntgenstr

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“…Sensitivity for pneumo-and or hemothorax ranged from 53.6% to 79.2% and specificity ranged from 99.3% to 100.0%. Sensitivity for pelvic fractures ranged from 64.4% to 85.7% and specificity ranged from 99.0%-100.0% [13]. When comparing this to the results of this study, diagnostic properties for iTBCT scout seem inferior to the properties of the Lodox statscan.…”

Section: All Observers (4)mentioning

confidence: 47%

Early detection of severe injuries after major trauma by immediate total-body CT scouts

Treskes

Russchen

Beenen

et al. 2020

Injury

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Introduction: Evaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. Methods: All patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Interobserver agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo-and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. Results: In total 220 patients with a median age of 37 years (IQR 26-59) were selected with a median Injury Severity Score of 18 (IQR 9-27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo-and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%-22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%-100%) and 50% (95%CI 22%-78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%-98%) and 22% (95%CI 4%-60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. Conclusions: iTBCT scouts can be useful for early detection of pneumo-and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.

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“…LODOX® is the radiological equivalent of a POC test as it can provide a full body X-ray within 19 s without the patient leaving the ED. Its utility in trauma patients is reasonably well-known but its use as a diagnostic tool for non-trauma patients in the ED has not been evaluated previously [12]. Diagnostic tests Cost Point-of-Care equivalent Cost Complete Blood Count4.57CBC (CEL-DYN Emerald 22)2.33Urea, Creatinine, ElectrolytesBlood Gas17.89i-STAT Chem8 CG4+27.61X-ray121.58LODOX®104.17TOTAL$ 144.04 a TOTAL$ 134.11 a $ Costs shown in US dollars for each individual test CBC Complete Blood Count, ECG electrocardiogram, i-STAT i-STAT POC tests, LODOX ® Low-dose x-ray a The direct comparison of net costs for testing between the groups if the costs of the tests alone are shown in isolation at face value i.e.…”

Section: Methodsmentioning

confidence: 99%

The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial

Goldstein

Wells

Vincent-Lambert

2019

Scand J Trauma Resusc Emerg Med

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BackgroundTime-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the time-saving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints.MethodsThis was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost-Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account.ResultsThere were 897 medical patients randomised to receive various combinations of POC tests. The most cost-effective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical.ConclusionsIn certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations – the most economical POC test combination being the i-STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money.Trial registrationClinicalTrials.gov: NCT03102216.

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Use of a full-body digital X-ray imaging system in acute medical emergencies: a systematic review

Cited by 11 publications

References 37 publications

Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Early detection of severe injuries after major trauma by immediate total-body CT scouts

The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial

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