Single Pass Whole-Body versus Organ-Selective Computed Tomography for Trauma: Timely diagnosis versus radiation exposure? – An observational Study (original) (raw)
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Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2020
Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to organ-selective CT (OSCT), and it does not inflict further delays in diagnosis. Materials and methods: We retrospectively review all trauma patients in whom CT scans were performed on arrival at a level I trauma center, from January 2016 to December 2017. Results: A total of 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma, and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma, and head injuries were the most common (71.9%). The OSCT group required subsequent follow-up studies to rule out other injuries, which in turn did not occur in the WBCT group (47.2% vs 0%, p < 0.001). The total radiation exposure dose was higher in the OSCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p < 0.001]. The median CT scan-to-diagnosis time was lower in the WBCT group [22 minutes (14-32) vs 32 minutes (21-65); p < 0.001]. Conclusion: The OSCT has the potential of missing potentially life-threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient's overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in diagnosis. Level of evidence: V, therapeutic.
The British journal of radiology, 2015
Objectives: To determine the number of imaging examinations, radiation dose, and the time to complete trauma-related imaging in multiple trauma patients before and after introduction of whole-body CT (WBCT) into early trauma care. Methods: 120 consecutive patients before and 120 patients after introduction of WBCT into our hospitals' trauma algorithm were compared regarding number and type of CT, radiography, focused assessment with sonography for trauma (FAST), additional CT examinations (defined as CT of same body regions after radiography and/or FAST), and the time to complete trauma-related imaging. Results: In the WBCT cohort significantly more patients underwent CT of the head, neck, chest, and abdomen (P<.001) as compared to the non-WBCT cohort, whereas the number of radiography of the cervical spine, chest and pelvis and of FAST examinations were significantly lower (P<.001). There were no significant differences between cohorts regarding the number of radiography ...
BMC Emergency Medicine, 2012
Background: Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. Methods/design: The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, nonpregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness.
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...
Rapid imaging protocol in trauma: a whole-body dual-source CT scan
Emergency Radiology, 2013
The purpose of this study is to determine whether a single acquisition whole-body trauma multi-detector CT scan is able to reduce resuscitation time, scan time, and effective radiation dose without compromising diagnostic quality in the setting of polytrauma. Retrospective analysis of 33 trauma patients undergoing single acquisition whole-body CT with injury severity scores of ≥16 was compared to 34 patients imaged with a segmented whole-body CT protocol. Time spent in the emergency department, effective radiation dose, image quality, and mortality rates were compared. The single acquisition group spent 53.7 % less time in the emergency department prior to imaging (p=0.0044) and decreased scanning time by 25 %. The protocol yielded a 24.5 % reduction in mean effective radiation dose (24.66 mSv vs. 32.67 mSv, p<0.0001). The image noise was similar in both groups. Standardized mortality ratios were comparable. The single acquisition protocol significantly reduces time spent in the emergency department by allowing faster imaging at a lower radiation dose while maintaining image quality. Other contributors to reduction in radiation dose include use of dual-source CT technology, removal of delayed CT intravenous pyelogram, and arm positioning.
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 ...
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.