The inception of the Bastion Protocol for trauma CT scanning

AbstractDuring Operation HERRICK, increasing numbers of battlefield casualties resulted in the need for innovation in the medical management of trauma. The aim of diagnostic radiology was to provide fast and accurate diagnostic information to the trauma team. The Bastion Protocol Computed Tomography (CT) Traumagram played a vital part in achieving this aim in the Joint Force Role 3 Medical Treatment Facility (R3), Camp Bastion.The CT Traumagram comprises a non-contrast CT scan of the head, followed by a biphasic intravenous contrast injection with single-pass acquisition from the Circle of Willis to the ischial tuberosities or as far down the legs as is necessary. Diagnostic CT, once a time-consuming process, became one of the major medical successes of Operation HERRICK. As a result, the Bastion Protocol, in modified forms, has been widely accepted and adopted in civilian trauma practice throughout the United Kingdom (UK). This paper aims to document the inception of the Bastion Protocol.

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Trauma Computed Tomography in the Modern Era: Not Always Quick and Safe

The American Surgeon ◽

10.1177/00031348211061330 ◽

2021 ◽

pp. 000313482110613

Author(s):

Cameron Ghafil ◽

Kazuhide Matsushima ◽

Hiroto Chiba ◽

Renqing Wu ◽

Heeseop Shin ◽

...

Keyword(s):

Computed Tomography ◽

Adverse Events ◽

Ct Scanning ◽

Trauma Team ◽

Whole Body ◽

Trauma Patients ◽

Diagnostic Modality ◽

Scanning Process ◽

Whole Body Ct ◽

Trauma Ct

Background Computed tomography (CT) has emerged as the diagnostic modality of choice in trauma patients. Recent studies suggest its use in hemodynamically unstable patients is safe and potentially lifesaving; however, the incidence of adverse events (AE) during the trauma CT scanning process remains unknown. Study Design Over a 6-month period at a Level 1 trauma center, data on patients undergoing trauma CT (whole-body CT (WBCT) +/− additional CT studies) were prospectively collected. All patients requiring a trauma team activation (TTA) were included. Adverse events and specific time intervals were recorded from the time of TTA notification to the time of return to the resuscitation bay from the CT suite. Results Of the 94 consecutive patients included in the study, 47.9% experienced 1 or more AE. Median duration away from the resuscitation bay for all patients was 24 minutes. Patients with AE spent a significantly longer time away from the resuscitation bay and had longer scan times. Vasopressor support and ongoing transfusion requirement at the time of CT scanning were associated with AE. Conclusion Adverse events of varying clinical significance occur frequently in patients undergoing emergent trauma CT. A standard trauma CT protocol could improve the efficiency and safety of the scanning process.

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How to deliver an effective primary survey report for the trauma CT: A radiological and surgical perspective

Trauma ◽

10.1177/1460408621995144 ◽

2021 ◽

pp. 146040862199514

Author(s):

Joseph Davies ◽

Rowena Johnson ◽

Elika Kashef ◽

Mansoor Khan ◽

Elizabeth Dick

Keyword(s):

Multidetector Ct ◽

Injured Patient ◽

Trauma Team ◽

Whole Body ◽

Primary Survey ◽

Survey Report ◽

Contrast Enhanced ◽

Trauma Ct ◽

Time Critical ◽

Critical Intervention

Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention. In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report. We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment.

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CT demonstration of spontaneous internal carotid artery dissection

Journal of Neurosurgery ◽

10.3171/jns.1985.63.5.0792 ◽

1985 ◽

Vol 63 (5) ◽

pp. 792-793 ◽

Cited By ~ 9

Author(s):

David J. Lubbers ◽

Thomas A. Tomsick

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Ct Scanning ◽

Carotid Artery Dissection ◽

Radiographic Evaluation ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Intravenous Contrast ◽

Content Type

✓ A case of internal carotid artery dissection is presented. It was diagnosed by computerized tomography (CT) and confirmed by angiography. The typical clinical presentation and radiographic evaluation are briefly reviewed. High-resolution CT scanning with intravenous contrast enhancement is a valuable diagnostic aid in the diagnosis of this entity.

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Trauma CT scanning; is there an awareness of the ionising radiation involved?

Clinical Radiology ◽

10.1016/j.crad.2013.05.029 ◽

2013 ◽

Vol 68 ◽

pp. S5

Author(s):

David Roberts ◽

Emma Rowbotham ◽

Sophie Dennis

Keyword(s):

Ct Scanning ◽

Ionising Radiation ◽

Trauma Ct

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A novel multiple-trauma CT-scanning protocol using patient repositioning

Emergency Radiology ◽

10.1007/s10140-006-0490-z ◽

2006 ◽

Vol 13 (3) ◽

pp. 123-128 ◽

Cited By ~ 16

Author(s):

Hanno Hoppe ◽

Peter Vock ◽

Harald Marcel Bonel ◽

Christoph Ozdoba ◽

Jan Gralla

Keyword(s):

Multiple Trauma ◽

Ct Scanning ◽

Scanning Protocol ◽

Trauma Ct

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CT Findings of Acute Stroke– Study of 321 Cases

TAJ Journal of Teachers Association ◽

10.3329/taj.v32i1.42684 ◽

2019 ◽

Vol 32 (1) ◽

pp. 17-24

Author(s):

Md Durrul Huda ◽

Niranjan Kumar Saha ◽

Quamruddin Ahmad ◽

Md Kafil Uddin ◽

Md Munzur Alahi ◽

...

Keyword(s):

Acute Stroke ◽

Neurological Diseases ◽

Adult Life ◽

Ct Scanning ◽

Haemorrhagic Stroke ◽

Cranial Computed Tomography ◽

Intravenous Contrast ◽

Ct Findings ◽

Stroke Study ◽

Monitoring Devices

Stroke ranks first in frequency among all the neurological diseases of adult life and about 50% of all neurological disorders in a hospital are of this type. It is the third leading cause of death throughout the world. The purpose of the present study was to find out the presence or absence of haemorrhage or infarct and to detect the early signs of stroke on the basis of CT scanning. Three-hundred twenty one consecutive acute stroke patients (mean age 64 ±9.75 years) were included in our study. Each underwent cranial computed tomography without intravenous contrast injection within the first 24 hours. CT findings of stroke were analyzed using SPSS software. Among 321 patients, 209(65.11%) had ischemic stroke, 99(30.84%) had parenchymal haemorrhage and 13(4.05%) had subarachnoid haemorrhage. Total amount of haemorrhagic stroke was 112(34.89%). Early CT findings of ischaemic stroke were low attenuation area (83.25%), sulcal effacement (69.89%), loss of the insular ribbon (17.70%), hyperdense artery sign (1.43%). CT scanning should be the first line of investigation for diagnosis of acute stroke as it is more available than MRI and is easily performed in severely ill patients who are dependent on support and monitoring devices TAJ 2019; 32(1): 17-24

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What Is the Clinical Evidence Supporting Trauma Team Training (TTT): A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina55090551 ◽

2019 ◽

Vol 55 (9) ◽

pp. 551

Author(s):

Noonan ◽

Olaussen ◽

Mathew ◽

Mitra ◽

Smit ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Patient Outcomes ◽

Meta Analysis ◽

Ct Scanning ◽

Trauma Team ◽

Team Training ◽

Cochrane Library ◽

Medical Subject Headings ◽

Mesh Terms

Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome.

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