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Whole-body computed tomography (WBCT) has become a widely used technique for the workup of the patient with blunt polytrauma.
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Current evidence suggests that WBCT is associated with improved or no change in patient survival and reduces the emergency department (ED) length of stay (LOS).
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However, randomized studies, at least one of which is underway, are needed to determine for certain whether early WBCT improves survival, to clarify which patients benefit the most and to model the costs of this
Improving Outcomes in the Patient with Polytrauma: A Review of the Role of Whole-Body Computed Tomography
Section snippets
Key points
Definition of whole-body computed tomography in trauma
The techniques used for WBCT (otherwise known as pan-scan or total-body CT) in trauma vary tremendously, but generally, WBCT is considered to include CT of the head, neck, chest, abdomen, and pelvis during a single visit to the CT scanner. Less commonly, CT has been used to refer specifically to thoracoabdominal CT for trauma. Usually, a WBCT scan comprises a CT of the head without intravenous contrast, CT of the cervical spine (acquired before, or following, intravenous contrast), and CT of
Indications for whole-body computed tomography in trauma
There is no consensus in the literature and no validated clinical prediction rule that defines clear criteria for WBCT following trauma or to define patients in whom WBCT can be safely omitted. In the published studies to date, a range of indications have been applied to select patients with trauma for WBCT rather than selective CT. Broadly, indications for WBCT have included the mechanism of injury, injury location or pattern, initial vital signs, or a combination of these.17
Impact of whole-body computed tomography on patient mortality
A recent Cochrane systematic review attempted to assess the effects of routine thoracoabdominal CT compared with selective CT on mortality in patients with high-energy blunt trauma.20 This systematic review noted the absence of any randomized controlled trials meeting their inclusion criteria and concluded that “while the diagnostic value of WBCT seems clear, its benefits on mortality cannot be established.”
Several prospective observational studies and retrospective cohort studies have been
Arm Positioning and Imaging Quality
There is no consensus regarding the best WBCT technique. Varying approaches categorized into 2 broad groups, multipass and single pass, have been described.
A multipass CT acquisition technique generally involves separate helical CT phases of different body regions. Typically, this approach involves noncontrast CT of the head and cervical spine, with the upper extremities resting beside the patient’s torso. Following acquisition of the cervical spine, the upper extremities are raised beside the
Incidental findings
Incidental radiologic findings are findings totally unrelated to the referring clinician’s reason for obtaining the study, for which the term incidentaloma has been coined.71 As the frequency and scope of medical imaging obtained on patients in the ED has increased, so too has the detection of unrelated but potentially clinically significant incidental findings. Some of the most common examples include small nodules in the lungs and adrenal gland. Several of these demonstrate imaging features
Summary
WBCT has become a widely used technique for the workup of the patient with blunt polytrauma. Evidence suggests that WBCT is associated with improved or no change in patient survival and reduces the ED LOS. However, randomized studies, at least one of which is underway, are needed to determine for certain whether early WBCT improves survival, to clarify which patients benefit the most, and to model the costs of this technique compared with traditional workup. Advancements in modern MDCT
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Cited by (25)
Utilization of torso computed tomography for the evaluation of ground level falls: More imaging does not equal better care
2023, InjuryCitation Excerpt :Another study with n=152 patients undergoing WBCT found that WBCT led to a significant change in management for only 3 (2%) of GLF patients, with 1 change involving the chest and 2 changes involving the cervical spine [16]. Previous studies have suggested that more conservative use of CT imaging may be beneficial for patients presenting with GLF [1,14–20]. This is especially pertinent for torso imaging, as patients who are found down very rarely have intra-abdominal injury and thus most likely will not benefit from abdominal CT imaging [21].
Variability in CT imaging of blunt trauma among ED physicians, surgical residents, and trauma surgeons
2017, Journal of Surgical ResearchCitation Excerpt :After the initial assessment and resuscitation is completed and the patient is stabilized, diagnostic imaging is performed to identify injuries that are not evident clinically. Computed tomography (CT) imaging is used routinely as a screening and diagnostic tool to identify injuries in trauma patients.9–11 However, there has been some debate as to whether or not the benefit outweighs the risk and higher cost.
R-SCAN: Whole-Body Blunt Trauma CT Imaging
2017, Journal of the American College of RadiologyIntroduction of a pan-scan protocol for blunt trauma activations: what are the consequences?
2017, American Journal of Emergency MedicineCitation Excerpt :Several European registry-based studies have identified and confirmed a decrease in mortality at centers where a PS is used. However, there are several concerns with the designs of these studies [2,3]. In addition, there has been increasing concern on whether or not the benefits outweigh the risks [4,5].
Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?
2016, InjuryCitation Excerpt :In major blood loss, low fibrinogen has been shown to indicate developing acute coagulopathy of trauma [26]. Early trauma computed tomography (CT) imaging has been fundamental to advances in trauma management, improving survival even in haemodynamically unstable patients [27–32]. NHS England standard contract for Major trauma Centres states a maximum time to CT of 60 min and ideal time of less than 30 min [33].