Pan vs. Selective Computed Tomography Scans in Management of Multiple Trauma Patients; a Brief Report
Archives of Academic Emergency Medicine,
Vol. 5 No. 1 (2017),
1 January 2017
,
Page e38
https://doi.org/10.22037/aaem.v5i1.162
Abstract
Introduction:Â Using pan or selective computed tomography (CT) scan in management of multiple trauma patient is a matter of debate. Therefore, the present study was designed aiming to compare the findings of pan and selective CT scans in management of multiple trauma patients.
Method:Â This is a prospective cross-sectional study, on patients presented to the emergency department (ED) of Shohadaye Haftome Tir Hospital, Tehran, Iran, following blunt multiple trauma over a 1-year period, from March 2014 to March 2015. Findings regarding presence or absence of injury in head, face, neck, chest, abdomen and hip were compared between patients that underwent pan and selective CT using SPSS 21.
Results: 443 patients with the mean age of 34.54 ± 17.88 years were evaluated (78% male). 248 (56%) patients underwent selective CT scan and 195 (44%) underwent pan CT scan. The 2 groups were similar regarding vital signs and mean age. Mean hospital length of stay was 21.05 ± 24.64 days for selective CT scan group and 18.18 ± 22.75 days for the other one (p = 0.209). A significant difference was only seen regarding findings of chest injury between the 2 groups (p < 0.001). In other cases a proper overlap was seen between findings of the 2 groups.
Conclusion:Â Based on the results of the present study, it seems that doing selective CT scan yields results similar to pan CT in detection of head and face, neck and abdomen and hip injuries in multiple trauma patients. However, using pan CT in these patients led to 16% increase in detection and diagnosis of traumatic intra-thoracic injuries.Â
- Tomography
- x-ray computed
- multiple trauma
- whole body imaging
- emergency service
- hospital
- diagnostic techniques and procedures
How to Cite
References
Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal†chest radiograph? Journal of Trauma and Acute Care Surgery. 2001;51(6):1173-6.
Livingston DH, Lavery RF, Passannante MR, Skurnick JH, Fabian TC, Fry DE, et al. Admission or observation is not necessary after a negative abdominal computed tomographic scan in patients with suspected blunt abdominal trauma: results of a prospective, multi-institutional trial. Journal of Trauma and Acute Care Surgery. 1998;44(2):273-82.
Matsubara T, Fong H, Burns C. Computed tomography of abdomen (CTA) in management of blunt abdominal trauma. Journal of Trauma and Acute Care Surgery. 1990;30(4):410-4.
Wolfman NT, Bechtold RE, Scharling E, Meredith J. Blunt upper abdominal trauma: evaluation by CT. AJR American journal of roentgenology. 1992;158(3):493-501.
Pevec W, Peitzman A, Udekwu A, McCoy B, Straub W. Computed tomography in the evaluation of blunt abdominal trauma. Surgery, gynecology & obstetrics. 1991;173(4):262-7.
PEITZMAN AB, MAKAROUN MS, SLASKY BS, RITTER P. Prospective study of computed tomography in initial management of blunt abdominal trauma. Journal of Trauma and Acute Care Surgery. 1986;26(7):585-92.
Gupta M, Schriger DL, Hiatt JR, Cryer HG, Tillou A, Hoffman JR, et al. Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma. Annals of emergency medicine. 2011;58(5):407-16. e15.
Huber-Wagner S, Lefering R, Qvick L-M, Körner M, Kay MV, Pfeifer K-J, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet. 2009;373(9673):1455-61.
Tillou A, Gupta M, Baraff LJ, Schriger DL, Hoffman JR, Hiatt JR, et al. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. Journal of Trauma and Acute Care Surgery. 2009;67(4):779-87.
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. Archives of Surgery. 2006;141(5):468-75.
Forouzanfar MM, Safari S, Niazazari M, Baratloo A, Hashemi B, Hatamabadi HR, et al. Clinical decision rule to prevent unnecessary chest Xâ€ray in patients with blunt multiple traumas. Emergency Medicine Australasia. 2014;26(6):561-6.
Safari S, Yousefifard M, Baikpour M, Rahimi-Movaghar V, Abiri S, Falaki M, et al. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma. Journal of Clinical Orthopaedics and Trauma. 2016.
Löw R, Düber C, Schweden F, Lehmann L, Blum J, Thelen M. [Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations]. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 1997;166(5):382-8.
Leidner B, Beckman M. Standardized whole-body computed tomography as a screening tool in blunt multitrauma patients. Emergency Radiology. 2001;8(1):20-8.
Ptak T, Rhea J, Novelline R. Experience with a continuous, single-pass whole-body multidetector CT protocol for trauma: the three-minute multiple trauma CT scan. Emergency Radiology. 2001;8(5):250-6.
Sampson M, Colquhoun K, Hennessy N. Computed tomography whole body imaging in multi-trauma: 7 years experience. Clinical radiology. 2006;61(4):365-9.
Wurmb T, Quaisser C, Balling H, Kredel M, Muellenbach R, Kenn W, et al. Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma. Emergency Medicine Journal. 2010:emj. 2009.082164.
Prokop A, Hötte H, Krüger K, Rehm K, Isenberg J, Schiffer G. [Multislice CT in diagnostic work-up of polytrauma]. Der Unfallchirurg. 2006;109(7):545-50.
Philipp M, Kubin K, Hörmann M, Metz V. Radiological emergency room management with emphasis on multidetector-row CT. European journal of radiology. 2003;48(1):2-4.
Kalra MK, Maher MM, Toth TL, Hamberg LM, Blake MA, Shepard J-A, et al. Strategies for CT Radiation Dose Optimization 1. Radiology. 2004;230(3):619-28.
Wurmb TE, Frühwald 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. Journal of Trauma and Acute Care Surgery. 2009;66(3):658-65.
Caputo ND, Stahmer C, Lim G, Shah K. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. The journal of trauma and acute care surgery. 2014;77(4):534-9.
Deunk J, Dekker HM, Brink M, van Vugt R, Edwards MJ, van Vugt AB. The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients. Journal of Trauma and Acute Care Surgery. 2007;63(4):757-63.
- Abstract Viewed: 277 times
- PDF Downloaded: 131 times
- HTML Downloaded: 61 times