Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Necessity for a Whole-body CT Scan in Alert Blunt Multiple Trauma Patients.

의식이 명료한 다발성 외상환자에게 전신 전산화단층촬영이 반드시 필요한가?

  • Mun, You-Ho (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Kim, Yun-Jeong (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Shin, Soo-Jeong (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Park, Dong-Chan (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Park, Sin-Ryul (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Ryu, Hyun-Wook (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Seo, Kang-Suk (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Park, Jung-Bae (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Chung, Jae-Myung (Department of Emergency Medicine College of Medicine, Kyungpook National University) ;
  • Bae, Ji-Hye (Department of Radiology College of Medicine, Kyungpook National University)
  • 문유호 (경북대학교 의과대학 응급의학교실) ;
  • 김윤정 (경북대학교 의과대학 응급의학교실) ;
  • 신수정 (경북대학교 의과대학 응급의학교실) ;
  • 박동찬 (경북대학교 의과대학 응급의학교실) ;
  • 박신율 (경북대학교 의과대학 응급의학교실) ;
  • 류현욱 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 정제명 (경북대학교 의과대학 응급의학교실) ;
  • 배지혜 (경북대학교 의과대학 영상의학교실)
  • Received : 2010.07.21
  • Accepted : 2010.09.27
  • Published : 2010.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was $44.6{\pm}18.9$ years. One hundred four (104, 71.2%) were men, and the injury severity score was $14.0{\pm}10.38$. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

Keywords

References

  1. Soto JA, Lucey BC, Stuhlfaut JW, Varghese JC. Use of 3D imaging in CT of the acute trauma patient: impact of a PACS-based software package. Emerg Radiol 2005;11:173-6. https://doi.org/10.1007/s10140-004-0384-x
  2. Gralla J, Spycher F, Pignolet C, Ozdoba C, Vock P, Hoppe H. Evaluation of a 16-MDCT scanner in an emergency department: initial clinical experience and workflow analysis. Am J Roentgenol 2005;185:232-8. https://doi.org/10.2214/ajr.185.1.01850232
  3. Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 1997;43:405-11. https://doi.org/10.1097/00005373-199709000-00003
  4. Watura R, Cobby M, Taylor J. Multislice CT in imaging of trauma of the spine, pelvis and complex foot injuries. Br J Radiol 2004;77:S46-63. https://doi.org/10.1259/bjr/52620263
  5. Hilbert P, zur Nieden K, Hofmann GO, Hoeller I, Koch R, Stuttmann R. New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. Injury 2007;38:552-8. https://doi.org/10.1016/j.injury.2006.12.023
  6. Wurmb TE, Fruhwald P, Hopfner W, Keil T, Kredel M, Brederlau J, et al. Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. J Trauma 2009;66:658-65. https://doi.org/10.1097/TA.0b013e31817de3f4
  7. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000;231:804-13. https://doi.org/10.1097/00000658-200006000-00004
  8. Wu SC, Chow KC, Lee KH, Tung CC, Yang AD, Lo CJ. Early selective angioembolization improves success of nonoperative management of blunt splenic injury. Am Surg 2007;73:897-902.
  9. Brenner D, Elliston C. Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004;232:735-8. https://doi.org/10.1148/radiol.2323031095
  10. Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, et al. Recurrent CT, Cumulative Radiation Exposure, and Associated Radiation-induced Cancer Risks from CT of Adults. Radiology 2009;251:175-84. https://doi.org/10.1148/radiol.2511081296
  11. Wurmb TE, Fruhwald P, Hopfner W, Roewer N, Brederlau J. Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication. Am J Emerg Med 2007;25:1057-62. https://doi.org/10.1016/j.ajem.2007.03.016
  12. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006;141:468-73. https://doi.org/10.1001/archsurg.141.5.468
  13. Self ML, Blake AM, Whitley M, Nadalo L, Dunn E. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. Am J Surg 2003;186:609-13. https://doi.org/10.1016/j.amjsurg.2003.08.003
  14. Schenarts PJ, Diaz J, Kaiser C, Carrillo Y, Eddy V, Morris JA Jr. Prospective comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma 2001;51:663-9. https://doi.org/10.1097/00005373-200110000-00007
  15. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000;343:94-9. https://doi.org/10.1056/NEJM200007133430203
  16. Deunk J, Poels TC, Brink M, Dekker HM, Kool DR, Blickman JG, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma 2010;68:387-94. https://doi.org/10.1097/TA.0b013e3181a7bdbd
  17. Wilson H, Ellsmere J, Tallon J, Kirkpatrick A. Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation? Injury 2009;40:928-31. https://doi.org/10.1016/j.injury.2009.04.005
  18. Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med 2009;54:575-84. https://doi.org/10.1016/j.annemergmed.2009.04.007
  19. Stengel D, Frank M, Matthes G, Schmucker U, Seifert J, Mutze S, et al. Primary pan-computed tomography for blunt multiple trauma: can the whole be better than its parts? Injury 2009;40 Suppl 4:S36-46. https://doi.org/10.1016/j.injury.2009.10.035
  20. Snyder GE. Whole-body imaging in blunt multisystem trauma patients who were never examined. Ann Emerg Med 2008;52:101-3. https://doi.org/10.1016/j.annemergmed.2007.03.023