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08.03.2018 | Original Article | Ausgabe 3/2019

European Journal of Trauma and Emergency Surgery 3/2019

Assessment of sensitivity of whole body CT for major trauma

Zeitschrift:
European Journal of Trauma and Emergency Surgery > Ausgabe 3/2019
Autoren:
Susan Yoong, Ravi Kothari, Adam Brooks
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00068-018-0926-7) contains supplementary material, which is available to authorized users.

Abstract

Introduction

Whole body computed tomography has become standard practice in many centres in the management of severely injured trauma patients, however, the evidence for it’s diagnostic accuracy is limited.

Aim

To assess the sensitivity of whole body CT in major trauma.

Method

Retrospective review of all patients with injury severity score (ISS) > 15 presenting with blunt trauma to a UK Major Trauma Centre between May 2012 and April 2014. Injuries were classified as per ISS score—1 = head and neck 2 = face 3 = chest 4 = abdomen. The authors reviewed patient’s electronic charts, radiological results; interventional procedure records, discharge letters and outpatient follow up documentation and referenced this with Trauma Audit and Research Network data.

Results

407 patients with ISS > 15 presented to the Trauma centre during May 2012 and April 2014. Of these, 337 (82.8%) had a whole body CT scan. 246 pts were male, 91 were female. 74 (21.9%) were due to a fall from > 2 m, 41 (12.2%) due to a fall from < 2 m, 208 (61.7%) were due to motor vehicle crashes, 1 (0.3%) due to a blast injury, 5 (1.5%) due to blows, and 8 (2.4%) due to crush injuries. Sensitivity for Region 1 was 0.98, Region 2 = 0.98, Region 3 = 0.98 and Region 4 was 0.95. Overall sensitivity was 0.98. 15 injuries (2.4%) were not identified on initial CT (false −ve). These injuries were: colonic perforation = 1, splenic contusion = 1, pneumothorax = 1, liver laceration = 1, intracranial haemorrhage = 1, cerebral contusions = 1, spinal injuries = 7, canal haemorrhage = 1, maxilla fracture = 1.

Conclusion

These results show that whole body CT in trauma has a high sensitivity and a low rate of missed injuries (2.4%). However, our study only evaluated a subgroup of patients with ISS > 15 and further work is required to assess the use of this investigation for all major trauma patients.

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