Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma? (original) (raw)
Related papers
European Journal of Emergency Medicine, 2012
We sought to identify the impact of whole-body computed tomography (WBCT) on working and suspected diagnoses in Emergency Department (ED) trauma patients and to determine the rate of WBCT scans with no detectable traumatic injuries. We performed a retrospective database analysis of all trauma patients who underwent WBCT in 2009, comparing pretest suspicion of specific injury to WBCT findings, looking for the rates of unexpected findings and the absence of traumatic injury in WBCT studies. Our results showed that of the 179 patients who underwent WBCT, no traumatic injury reported in 17 patients while 162 patients demonstrated pathology (47 confirming previously suspected or diagnosed injury and 115 with previously unexpected injury). Overall, WBCT results differed from clinical findings in 130 (72.6%) patients, a statistically significant difference (P < 0.0001). In conclusion, WBCT identifies previously unexpected injuries in almost 66% of ED trauma patients, supporting its continued use in the initial assessment of trauma patients.
European Journal of Trauma and Emergency Surgery, 2020
Purpose The indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI). Methods Prospective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square). Results 1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regi...
Whole-body computed tomography in severely injured patients
Current Opinion in Critical Care, 2018
Purpose of review To provide an update on the relevant and recent studies on whole-body computed tomography (WBCT) imaging of severely injured patients. Recent findings The advantages of WBCT in time saving, diagnostic accuracy and even in survival have been proven in numerous studies. WBCT can also be beneficial in haemodynamically unstable major trauma patients. The CT scanner should be located close to the emergency department or even in the trauma room. The issue of radiation is still quite important, however, iterative as well as split-bolus protocols can nowadays reduce radiation significantly. The question: which trauma patient should receive WBCT and which not is not yet solved sufficiently. Postmortem WBCT has a promising potential to promptly define the definitive cause of death of trauma victims comparably to traditional autopsy. Summary On account of the recent advances, whole-body CT has become a crucial part of the initial in-hospital assessment of severely injured patients. It is recommended as the standard radiological tool for the emergency diagnostic work-up in major trauma patients.
Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2015
Background There is an important increase in the use of whole body computed tomography (WBCT) around the world although its benefits are still controversial. We hypothesized that the use of a WBCT protocol in the major trauma patients based on mechanism of injury alone would reduce the number of injuries that would have been missed if CT was only done based on clinical findings. Study design A prospective observational study with the inclusion of 144 patients with major blunt trauma during 5 months at our academic center. Data were collected from all patients including: epidemiology, clinical status on scene and at the emergency department, time of the scan (including patient handling), clinical findings during initial assessment and WBCT scan findings, dividing exams in with or without findings (normal). Looking for findings that would go unnoticed if CT was done based on clinical findings. Glasgow coma scale (GCS) 15 and GCS <15 were compared and data are presented as absolute ...
Emergency medicine journal : EMJ, 2017
Whole-body CT (WBCT) use in patients with trauma in England and Wales is not well documented. WBCT in trauma can reduce time to definitive care, thereby increasing survival. However, its use varies significantly worldwide. We performed a retrospective observational study of Trauma Audit and Research Network (TARN) data from 2012 to 2014. The proportion of adult patients receiving WBCT during initial resuscitation at major trauma centres (MTCs) and trauma units/non-designated hospitals (TUs/NDHs) was compared. A model was developed that included factors associated with WBCT use, and centre effects within the model were explored to determine variation in usage beyond that expected from the model. Of the 115 664 study participants, 16.5% had WBCT. WBCT was performed five times more frequently in MTCs than in TUs/NDHs (31% vs 6.6%). In the multivariate model, increased injury severity, low GCS, shock, comorbidities and triage category increased the chances of having a WBCT, but there wa...
Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study
The Lancet, 2009
Background The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any eff ect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not.
Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma
Critical Care, 2012
The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma. The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30day mortality. Results: In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups. Conclusions: Diagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.
Hong Kong Journal of Emergency Medicine, 2018
Backround: High rates in trauma-related mortality pose a major health problem and increase every day. Early diagnosis and treatment can be lifesavers for this patient group in the emergency departments, which serve as the first place to admit trauma patients in a hospital. Objectives: We aim to determine high-risk criteria to indicate trauma patients getting the most use from whole-body tomography in patients with multiple traumas and reduce unnecessary computed tomography. Methods: We examined retrospectively all electronic files and computed tomography results of patients, who had been admitted to emergency department due to trauma, and who had undergone whole-body computed tomography. Results: We found that possibility of multiple injuries increased by 5.9 times in patients requiring mechanical ventilation. Possibility of multiple injuries in patients with free fluid in the Focused Assessment with Sonography for Trauma increased by 5.6 times. We also observed that possibility of ...
Annals of Medical Research
The aim of this study was to investigate the frequency of incidental findings and the clinically significant ones in whole-body computed tomography (WBCT) scans in multiple trauma patients in the emergency department (ED). Material and Methods: This study was designed as a single-centered retrospective cohort in a tertiary emergency room. Multiple trauma patients who were screened with WBCT in the ED in 2017 were analyzed. Incidental findings (IF) were categorized into 3 groups as group 1 (emergency treatment / need further examination), group 2 (need examination depending on the symptoms of patients) and group 3 (minor findings with no need for further examination). Results: WBCT screening was performed in 206 of 3746 patients (5.4%) who were admitted to the trauma unit in ED due to multiple traumas. A total of 360 IFs were found in 138 (67%) of 206 patients. Of the patients, 13.3% were classified as group 1, 30.9% as group 2, 55.8% as group 3 and IF was detected, respectively (48, 111, 201). Cardiomegaly was the most common finding in group 1 (n = 11). In group 2, hepatomegaly (n = 18) and atherosclerosis (n = 13) were the most common ones observed. Brain calcifications (n = 42) and renal cysts (n = 17) were the most common findings in Group 3. The age distribution of patients with IF was statistically significantly higher compared to those without IF (43.54 ± 18.78, 25.16 ± 11.7, p <0.001, respectively). Conclusion: WBCT is used in the ED with an increasing frequency in multiple trauma patients and causes incidental findings to occur significantly. Some of these findings may be vital and may require further clinical evaluation and follow-up.