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Erschienen in: European Journal of Trauma and Emergency Surgery 3/2012

01.06.2012 | Original Article

Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury

verfasst von: H.-C. Huang, C.-Y. Fu, C.-H. Hsieh, Y.-C. Wang, S.-C. Wu, R.-J. Chen, J.-C. Huang

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2012

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Abstract

Introduction

Traumatic brain injury (TBI) is a common diagnosis in the emergency department. Brain computed tomography (CT) has become a standard diagnostic tool with which to examine TBI patients. Conventional X-rays are ineffective for the evaluation of torso or extremity injuries. In the current study, we attempted to establish a diagnostic modality to evaluate systemically initially unconscious patients in the emergency department with a rapid screening technique characterized by sufficient information, low cost and low radiation exposure.

Materials and methods

From January 2008 to December 2009, patients with diminished level of consciousness received the Lodox/Statscan for evaluation of extracranial injuries were enrolled in this study. The accuracy of this diagnostic modality in detecting torso or extremity injuries in initially unconscious patients was analyzed by comparing the initial diagnosis (by the Lodox/Statscan) with the final diagnosis (confirmed by torso CT scan or after two weeks of follow-up).

Results

There were 1,210 patients with TBI whose extracranial injuries were evaluated by the Lodox/Statscan. After excluding intra-abdominal injuries, the overall sensitivity rates of the Lodox/Statscan in diagnosing torso injuries and extremity injuries were 89.7% and 90.2%, respectively. No long bone fracture was missed by the Lodox/Statscan. The sensitivity and specificity of the Lodox/Statscan in diagnosing long bone fractures were both 100%. Most patients with torso injuries that were missed by the Lodox/Statscan could be managed conservatively without further treatment or complications. All of the missed extremity injuries were distal bone fractures.

Conclusion

The Lodox/Statscan can provide benefits for surveying extracranial injuries in patients with diminished level of consciousness. The Lodox/Statscan also emits a notably low dose of radiation and appears to be a relatively inexpensive adjunct to screen torso or extremity injuries in TBI patients.
Literatur
1.
Zurück zum Zitat Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalization, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, 2004. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalization, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, 2004.
2.
Zurück zum Zitat Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil. 1999;14:602–15.PubMedCrossRef Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil. 1999;14:602–15.PubMedCrossRef
3.
Zurück zum Zitat French BN, Dublin AB. The value of computerized tomography in the management of 1000 consecutive head injuries. Surg Neurol. 1977;7:171–83.PubMed French BN, Dublin AB. The value of computerized tomography in the management of 1000 consecutive head injuries. Surg Neurol. 1977;7:171–83.PubMed
4.
Zurück zum Zitat Koo AH, LaRoque RL. Evaluation of head trauma by computed tomography. Radiology. 1977;123:345–50.PubMed Koo AH, LaRoque RL. Evaluation of head trauma by computed tomography. Radiology. 1977;123:345–50.PubMed
5.
Zurück zum Zitat Merino-deVillasante J, Taveras JM. Computerized tomography (CT) in acute head trauma. AJR Am J Roentgenol. 1976;126:765–78.PubMed Merino-deVillasante J, Taveras JM. Computerized tomography (CT) in acute head trauma. AJR Am J Roentgenol. 1976;126:765–78.PubMed
6.
Zurück zum Zitat Advanced trauma life support, 8th edn. Committee on Trauma, American College of Surgeons, Chicago, IL, 2008. Advanced trauma life support, 8th edn. Committee on Trauma, American College of Surgeons, Chicago, IL, 2008.
7.
Zurück zum Zitat Garland DE, Bailey S. Undetected injuries in head-injured adults. Clin Orthop Relat Res. 1981;155:162–5.PubMed Garland DE, Bailey S. Undetected injuries in head-injured adults. Clin Orthop Relat Res. 1981;155:162–5.PubMed
8.
Zurück zum Zitat Heinrich SD, Gallagher D, Harris M, Nadell JM. Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging. J Bone Joint Surg Am. 1994;76:561–72.PubMed Heinrich SD, Gallagher D, Harris M, Nadell JM. Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging. J Bone Joint Surg Am. 1994;76:561–72.PubMed
9.
Zurück zum Zitat Sobus KML, Alexander MA, Harcke HT. Undetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury. Arch Phys Med Rehabil. 1993;74:902–4.PubMedCrossRef Sobus KML, Alexander MA, Harcke HT. Undetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury. Arch Phys Med Rehabil. 1993;74:902–4.PubMedCrossRef
10.
11.
Zurück zum Zitat Juhl M, Møller-Madsen B, Jensen J. Missed injuries in an orthopaedic department. Injury. 1990;21(2):110–2.PubMedCrossRef Juhl M, Møller-Madsen B, Jensen J. Missed injuries in an orthopaedic department. Injury. 1990;21(2):110–2.PubMedCrossRef
12.
Zurück zum Zitat Laasonen EM, Kivioja A. Delayed diagnosis of extremity injuries in patients with multiple injuries. J Trauma. 1991;31:257–60.PubMed Laasonen EM, Kivioja A. Delayed diagnosis of extremity injuries in patients with multiple injuries. J Trauma. 1991;31:257–60.PubMed
13.
Zurück zum Zitat Olson SA, Rhorer AS. Orthopaedic trauma for the general orthopaedist: avoiding problems and pitfalls in treatment. Clin Orthop Relat Res. 2005;433:30–7.PubMedCrossRef Olson SA, Rhorer AS. Orthopaedic trauma for the general orthopaedist: avoiding problems and pitfalls in treatment. Clin Orthop Relat Res. 2005;433:30–7.PubMedCrossRef
14.
Zurück zum Zitat Boffard KD, Goosen J, Plani F, Degiannis E, Potgieter H. The use of low dosage X-ray (Lodox/Statscan) in major trauma: comparison between low dose X-ray and conventional X-ray techniques. J Trauma. 2006;60:1175–81.PubMedCrossRef Boffard KD, Goosen J, Plani F, Degiannis E, Potgieter H. The use of low dosage X-ray (Lodox/Statscan) in major trauma: comparison between low dose X-ray and conventional X-ray techniques. J Trauma. 2006;60:1175–81.PubMedCrossRef
15.
Zurück zum Zitat Chen RJ, Fu CY, Wu SC, Wang YC, Chung PK, Huang HC, Huang JC, Lu CW. Diagnostic accuracy, biohazard safety, and cost effectiveness—the Lodox/Statscan provides a beneficial alternative for the primary evaluation of patients with multiple injuries. J Trauma. 2010;69:826–30.PubMedCrossRef Chen RJ, Fu CY, Wu SC, Wang YC, Chung PK, Huang HC, Huang JC, Lu CW. Diagnostic accuracy, biohazard safety, and cost effectiveness—the Lodox/Statscan provides a beneficial alternative for the primary evaluation of patients with multiple injuries. J Trauma. 2010;69:826–30.PubMedCrossRef
16.
Zurück zum Zitat Beningfield SJ, Potgieter JH, Bautz P, Shackleton M, Hering E, de Jager G, Bowie G, Marshall M, Cox G, Pagliari G, Coetzee N. Evaluation of a new type of direct digital radiography machine. S Afr Med J. 1999;89:1182–8.PubMed Beningfield SJ, Potgieter JH, Bautz P, Shackleton M, Hering E, de Jager G, Bowie G, Marshall M, Cox G, Pagliari G, Coetzee N. Evaluation of a new type of direct digital radiography machine. S Afr Med J. 1999;89:1182–8.PubMed
17.
Zurück zum Zitat Mulligan ME, Flye CW. Initial experience with Lodox Statscan imaging system for detecting injuries of the pelvis and appendicular skeleton. Emerg Radiol. 2006;13:129–33.PubMedCrossRef Mulligan ME, Flye CW. Initial experience with Lodox Statscan imaging system for detecting injuries of the pelvis and appendicular skeleton. Emerg Radiol. 2006;13:129–33.PubMedCrossRef
18.
Zurück zum Zitat Fu CY, Wu SC, Chen RJ. Lodox/Statscan provides rapid identification of bullets in multiple gunshot wounds. Am J Emerg Med. 2008;26:965.e5–e7.CrossRef Fu CY, Wu SC, Chen RJ. Lodox/Statscan provides rapid identification of bullets in multiple gunshot wounds. Am J Emerg Med. 2008;26:965.e5–e7.CrossRef
19.
Zurück zum Zitat Knobel GJ, Flash G, Bowie GF. Lodox Statscan proves to be invaluable in forensic medicine. S Afr Med J. 2006;96:593–6.PubMed Knobel GJ, Flash G, Bowie GF. Lodox Statscan proves to be invaluable in forensic medicine. S Afr Med J. 2006;96:593–6.PubMed
20.
Zurück zum Zitat Ball CG, Nicol AJ, Beningfield SJ, Navsaria PH. Emergency room arteriography: an updated digital technology. Scand J Surg. 2007;96:67–71.PubMed Ball CG, Nicol AJ, Beningfield SJ, Navsaria PH. Emergency room arteriography: an updated digital technology. Scand J Surg. 2007;96:67–71.PubMed
21.
Zurück zum Zitat Exadaktylos AK, Benneker LM, Jeger V, Martinolli L, Bonel HM, Eggli S, Potgieter H, Zimmermann H. Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS. Injury. 2008;39:525–9.PubMedCrossRef Exadaktylos AK, Benneker LM, Jeger V, Martinolli L, Bonel HM, Eggli S, Potgieter H, Zimmermann H. Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS. Injury. 2008;39:525–9.PubMedCrossRef
22.
Zurück zum Zitat Compagnone G, Pagan L, Bergamini C. Effective dose calculations in conventional diagnostic X-ray examinations for adult and paediatric patients in a large Italian hospital. Radiat Prot Dosimetry. 2005;114:164–7.PubMedCrossRef Compagnone G, Pagan L, Bergamini C. Effective dose calculations in conventional diagnostic X-ray examinations for adult and paediatric patients in a large Italian hospital. Radiat Prot Dosimetry. 2005;114:164–7.PubMedCrossRef
23.
Zurück zum Zitat Huda W, Nickoloff EL, Boone JM. Overview of patient dosimetry in diagnostic radiology in the USA for the past 50 years. Med Phys. 2008;35:5713–28.PubMedCrossRef Huda W, Nickoloff EL, Boone JM. Overview of patient dosimetry in diagnostic radiology in the USA for the past 50 years. Med Phys. 2008;35:5713–28.PubMedCrossRef
24.
Zurück zum Zitat Irving BJ, Maree GJ, Hering ER, Douglas TS. Radiation dose from a linear slit scanning X-ray machine with full-body imaging capabilities. Radiat Prot Dosimetry. 2008;130:482–9.PubMedCrossRef Irving BJ, Maree GJ, Hering ER, Douglas TS. Radiation dose from a linear slit scanning X-ray machine with full-body imaging capabilities. Radiat Prot Dosimetry. 2008;130:482–9.PubMedCrossRef
26.
Zurück zum Zitat Tabuenca J, Truan JR. Knee injuries in traumatic hip dislocation. Clin Orthop Relat Res. 2000;377:78–83.PubMedCrossRef Tabuenca J, Truan JR. Knee injuries in traumatic hip dislocation. Clin Orthop Relat Res. 2000;377:78–83.PubMedCrossRef
27.
Zurück zum Zitat Berlin L. Defending the “missed” radiographic diagnosis. AJR Am J Roentgenol. 2001;176:317–22.PubMed Berlin L. Defending the “missed” radiographic diagnosis. AJR Am J Roentgenol. 2001;176:317–22.PubMed
28.
Zurück zum Zitat Wei CJ, Tsai WC, Tiu CM, Wu HT, Chiou HJ, Chang CY. Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol. 2006;47:710–7.PubMedCrossRef Wei CJ, Tsai WC, Tiu CM, Wu HT, Chiou HJ, Chang CY. Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol. 2006;47:710–7.PubMedCrossRef
29.
Zurück zum Zitat Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Investig Radiol. 1999;34:46–50.CrossRef Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Investig Radiol. 1999;34:46–50.CrossRef
30.
Zurück zum Zitat Kusano N, Churei Y, Shiraishi E, Kusano T. Diagnosis of occult carpal scaphoid fracture: a comparison of magnetic resonance imaging and computed tomography techniques. Tech Hand Up Extrem Surg. 2002;6:119–23.PubMedCrossRef Kusano N, Churei Y, Shiraishi E, Kusano T. Diagnosis of occult carpal scaphoid fracture: a comparison of magnetic resonance imaging and computed tomography techniques. Tech Hand Up Extrem Surg. 2002;6:119–23.PubMedCrossRef
31.
Zurück zum Zitat Murphy DG, Eisenhauer MA, Powe J, Pavlofsky W. Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracture? Ann Emerg Med. 1995;26:434–8.PubMedCrossRef Murphy DG, Eisenhauer MA, Powe J, Pavlofsky W. Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracture? Ann Emerg Med. 1995;26:434–8.PubMedCrossRef
32.
Zurück zum Zitat Deyle S, Brehmer T, Evangelopoulos DS, Krause F, Benneker LM, Zimmermann H, Exadaktylos AK. Review of Lodox Statscan in the detection of peripheral skeletal fractures in multiple injury patients. Injury. 2010;41:818–22.PubMedCrossRef Deyle S, Brehmer T, Evangelopoulos DS, Krause F, Benneker LM, Zimmermann H, Exadaktylos AK. Review of Lodox Statscan in the detection of peripheral skeletal fractures in multiple injury patients. Injury. 2010;41:818–22.PubMedCrossRef
33.
Zurück zum Zitat Obaid AK, Barleben A, Porral D, Lush S, Cinat M. Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department. Am Surg. 2006;72:951–4.PubMed Obaid AK, Barleben A, Porral D, Lush S, Cinat M. Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department. Am Surg. 2006;72:951–4.PubMed
34.
Zurück zum Zitat Berne JD, Velmahos GC, El-Tawil Q, Demetriades D, Asensio JA, Murray JA, Cornwell EE, Belzberg H, Berne TV. Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. J Trauma. 1999;47:896–903.PubMedCrossRef Berne JD, Velmahos GC, El-Tawil Q, Demetriades D, Asensio JA, Murray JA, Cornwell EE, Belzberg H, Berne TV. Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. J Trauma. 1999;47:896–903.PubMedCrossRef
35.
Zurück zum Zitat Platzer P, Jaindl M, Thalhammer G, Dittrich S, Wieland T, Vecsei V, Gaebler C. Clearing the cervical spine in critically injured patients: a comprehensive C-spine protocol to avoid unnecessary delays in diagnosis. Eur Spine J. 2006;15:1801–10.PubMedCrossRef Platzer P, Jaindl M, Thalhammer G, Dittrich S, Wieland T, Vecsei V, Gaebler C. Clearing the cervical spine in critically injured patients: a comprehensive C-spine protocol to avoid unnecessary delays in diagnosis. Eur Spine J. 2006;15:1801–10.PubMedCrossRef
36.
Zurück zum Zitat Woodring JH, Lee C. The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma. 1992;33:698–708.PubMedCrossRef Woodring JH, Lee C. The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma. 1992;33:698–708.PubMedCrossRef
Metadaten
Titel
Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury
verfasst von
H.-C. Huang
C.-Y. Fu
C.-H. Hsieh
Y.-C. Wang
S.-C. Wu
R.-J. Chen
J.-C. Huang
Publikationsdatum
01.06.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 3/2012
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0176-z

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