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

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.

Screening for carotid injury in trauma patients: image quality of 16-detector-row computed tomography angiography

2007 ◽  
Vol 48 (7) ◽  
pp. 798-805 ◽  
Author(s):  
I. Borisch ◽  
T. Boehme ◽  
B. Butz ◽  
O. W. Hamer ◽  
S. Feuerbach ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Carotid Artery ◽  
Computed Tomography Angiography ◽  
Whole Body ◽  
Multidetector Row Computed Tomography ◽  
Trauma Patients ◽  
Whole Body Ct ◽  
Body Ct

Background: The introduction of multidetector-row computed tomography (MDCT) has revolutionized the initial management of multiply injured patients. This technology has the potential to improve the imaging of traumatic vascular injuries. Purpose: To evaluate the quality of multidetector-row computed tomography angiography (MDCTA) of the carotid arteries in the setting of a routine whole-body trauma scan. Material and Methods: 87 trauma patients underwent a routine whole-body CT scan in a 16-detector-row scanner including an MDCTA with a reconstructed axial slice thickness of 3 mm. Images were reviewed by three experienced radiologists with emphasis on image quality. Contrast density, severity, and origin of artifacts and the occurrence of vessel lesions were assessed for different vessel segments. Results: 3642 separate vessel segments were evaluated. Contrast density was rated good or sufficient for diagnosis in 99.8%. A total of 67.3% of vessel segments were free of artifacts, while 27.9% of vessel segments showed minor artifacts not impairing diagnostic evaluation. Clinically relevant artifacts obscuring a vessel segment occurred in 4.7% and were mostly caused by dental hardware. Four dissections of the internal carotid artery were diagnosed by all three radiologists. Conclusion: As a rapid screening test for blunt carotid artery injury, integration of MDCTA in the routine imaging workup of trauma patients utilizing a whole-body CT trauma scan is possible and practicable. Image quality is mostly sufficient for diagnosis, but impaired in a few cases by artifacts deriving primarily from dental hardware.

scholarly journals Whole-Body CT in Multiple Trauma Patients: Clinically Adapted Usage of Differently Weighted CT Protocols

2018 ◽  
Vol 190 (12) ◽  
pp. 1141-1151 ◽  
Author(s):  
Stefan Reske ◽  
Rainer Braunschweig ◽  
Andreas Reske ◽  
Reinhard Loose ◽  
Michael Wucherer
Keyword(s):  
Multiple Trauma ◽  
Injury Severity ◽  
The Body ◽  
Whole Body ◽  
Clinical Approach ◽  
Trauma Patients ◽  
Diagnostic Modality ◽  
Whole Body Ct ◽  
Multiple Trauma Patients ◽  
Body Ct

Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011, 2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamically unstable pat. and DOSE protocol (DP) for pat. with stable vital parameters. The aim of this study was to compare the original “One-fits-all-concept” with the new, clinically oriented approach to wbCT. Materials and Methods This study retrospectively evaluated 3 distinct wbCT protocols, looking at automatic exposure control variation (AEC; OP/TP) and arm positioning close to the body/overhead (TP/DP). The analysis included waist circumference (WC, cm), injury severity score (ISS), examination time (ET, min), image noise (IN), and effective dose (E, mSv). Normality of distribution was assessed with the Kolmogorov-Smirnov test. Data are given as median and range. Test of significance with Kruskal-Wallis test or Mann-Whitney-U-test. Level of significance: 0.05. Results 308 pat. were included in the study (77 % m; age: 46 a, 18 – 90 a; WC: 93 cm, 66 – 145 cm). ISS was 14 (OP; n = 104; 0 – 75), 18 (TP; n = 102; 0 – 75) and 9 (DP; n = 102; 0 – 50). ET was 3.9 min (OP; 3.3 – 5.6 min), 4.1 min (TP; 2.8 – 7.2 min) and 7.7 min (DP; 6 – 10 min). IN showed no significant differences when comparing OP/TP but was significantly reduced in DP. For a wbCT (vertex to ischium), E could be reduced from 49.7 mSv to 35.4 mSv by optimizing AEC (OP/TP). Through the overhead repositioning of the arms in DP, a further reduction to 28.2 mSv was achieved. Conclusion AEC and arm repositioning have a crucial influence on image quality and dose. The presented clinical approach is superior to the original concept. Key Points: Citation Format

scholarly journals Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Rakuhei Nakama ◽  
Ryo Yamamoto ◽  
Yoshimitsu Izawa ◽  
Keiichi Tanimura ◽  
Takashi Mato
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
High Specificity ◽  
Whole Body ◽  
Cutoff Value ◽  
Whole Body Ct ◽  
Isolated Injury ◽  
D Dimer ◽  
Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

scholarly journals Plain Radiography May Be Safely Omitted for Selected Major Trauma Patients Undergoing Whole Body CT: Database Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sarah Hudson ◽  
Adrian Boyle ◽  
Stephanie Wiltshire ◽  
Lisa McGerty ◽  
Sara Upponi
Keyword(s):  
Major Trauma ◽  
Research Network ◽  
Whole Body ◽  
Trauma Patients ◽  
X Rays ◽  
Database Study ◽  
Primary Survey ◽  
Whole Body Ct ◽  
Plain Films ◽  
Body Ct

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.

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

Trauma ◽  
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.

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

2015 ◽  
Vol 81 (10) ◽  
pp. 1080-1083
Author(s):  
Andrea A. Zaw ◽  
Donovan Stewart ◽  
Jason S. Murry ◽  
David M. Hoang ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Chest Trauma ◽  
Aortic Injury ◽  
Whole Body ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Whole Body Ct ◽  
Appropriate Treatment ◽  
Urban Level ◽  
Level I

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition that requires rapid diagnosis for appropriate treatment. We compared CT with IV contrast (CTI) with CT with angiography (CTA) during the initial phase of care at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Overall, 281 patients met inclusion criteria with 167 (59%) CTI and 114 (41%) CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified any chest injury in 54 per cent of patients compared with 46 per cent with CTA ( P = 0.05). The rate of BAI was similar with CTI and CTA (2% vs 2%, P = 0.80), and neither modality was falsely negative. We conclude that CTI and CTA are similar at evaluating trauma patients for BAI, although CTI may be preferable during the initial assessment phase because the contrast injection may be combined with abdominal scanning and image time is reduced when whole-body CT is required.

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