Is Whole Body CT Safe and Cost Effective in Managing MT (Major Trauma) Patients in the Emergency Department (ED)?

Introduction. Whole body CT is being used increasingly in the primary survey of major trauma patients. We evaluated whether omitting plain films of the chest and pelvis in the primary survey was safe. We compared the probability of survival of patients and time to CT who had plain X-rays to those who did not.Method. We performed a database study on major trauma patients admitted between 2008 and 2010 using data from Trauma, Audit and Research Network (TARN) and our PACS system. We included adult major trauma patients who has an ISS of greater than 15 and underwent whole body CT.Results. 245 patients were included in the study. 44 (17.9%) did not undergo plain films. The median time to whole body CT from the time of admission was longer (47 minutes) in patients having plain films, than those who did not have plain films performed (30 minutes),P<0.005. Mortality was increased in the group who received plain films, 9.5% compared to 4.5%, but this was not statistically significant (P=0.77).Conclusion. We conclude that plain films may be safely omitted during the primary survey of selected major trauma patients.

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Prevalence and outcome of contrast-induced nephropathy in major trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01496-w ◽

2020 ◽

Author(s):

Julian Alexander Kelemen ◽

Alexander Kaserer ◽

Kai Oliver Jensen ◽

Philipp Stein ◽

Burkhardt Seifert ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Major Trauma ◽

Whole Body ◽

Trauma Patients ◽

Contrast Induced Nephropathy ◽

Whole Body Ct ◽

Contrast Enhanced ◽

Body Ct

Abstract Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

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Prospective Evaluation of a Protocol of Whole Body CT based only in Mechanism of Injury in Major Trauma Patients

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1119 ◽

2015 ◽

Vol 4 (2) ◽

pp. 66-69

Author(s):

Eduardo Rissi Silva ◽

Felipe Rossi ◽

Newton Djin Mori ◽

Diogo FV Garcia ◽

Edvaldo Utiyama

Keyword(s):

Glasgow Coma Scale ◽

Major Trauma ◽

Clinical Findings ◽

Whole Body ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Prospective Evaluation ◽

Coma Scale ◽

Whole Body Ct ◽

Body Ct

ABSTRACT 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 values of mean ± SD. Analysis of data was done with Chi-square test (p < 0.05). Results One hundred forty-four patients with major trauma that were included in the protocol. Normal CT scan was found in 44 cases and 100 scans had at least one positive finding associated with the trauma and 35 CTs (25%) had at least one injury that would be missed without the WBCT protocol. Glasgow coma scale of 15 patients and those with 14 or less were compared regarding the number of normal vs positive scan (p = 0.45) and for scans with unnoticed injuries (p = 0.1) and there was no difference between the two groups. Conclusion A significant number of injuries would have been missed if a WBCT scan protocol based on mechanism of injury was not used in our center. There was no difference in the number of probably missed injuries in patients with a GCS = 15 or those with GCS ≤14. How to cite this article Silva ER, Rossi F, Mori ND, Garcia DFV, Utiyama E. Prospective Evaluation of a Protocol of Whole Body CT based only in Mechanism of Injury in Major Trauma Patients. Panam J Trauma Crit Care Emerg Surg 2015;4(2):66-69.

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