Elisa Reitano1, Laura Briani2, Fabrizio Sammartano1, Stefania Cimbanassi1, Margherita Luperto1, Angelo Vanzulli3, Osvaldo Chiara4. 1. General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. 2. General Surgery and Trauma Team, ASST Niguarda Milano, University of Pavia, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. 3. Radiology Department, ASST Niguarda Milano, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. 4. General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. osvaldo.chiara@unimi.it.
Abstract
PURPOSE: To determine whether torso CT can be avoided in patients who experience high-energy blunt trauma but have normal vital signs. METHODS: High-energy blunt trauma patients with normal vital signs were retrieved retrospectively from our registry. We reviewed 1317 patients (1027 men and 290 women) and 761 (57.8%) fulfilled the inclusion criteria. All patients were initially evaluated at the emergency room (ER), with a set of tests, part of a specific protocol. Patients with at least one altered exam at initial examination or after six-hour observation received a torso CECT. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (NPV), and likelihood ratio (LH) of the protocol were evaluated. RESULTS: Of 761 patients, 354 (46.5%) received torso CECT because of the positive ER test, with 330 being true positive and 24 being false positive. The remaining 407 patients were negative at ER tests and did not receive torso CECT, showing a significantly (P < 0.001) lower Injury Severity Score (ISS). The positive and negative LH of the protocol to detect torso injuries were respectively 16.5 and 0.01 (overall accuracy of 0.96). CONCLUSIONS: Torso CT can be avoided without adverse clinical outcomes in patients who experience high-energy blunt trauma, are hemodynamically stable, and have normal initial laboratory and imaging tests.
PURPOSE: To determine whether torso CT can be avoided in patients who experience high-energy blunt trauma but have normal vital signs. METHODS:High-energy blunt traumapatients with normal vital signs were retrieved retrospectively from our registry. We reviewed 1317 patients (1027 men and 290 women) and 761 (57.8%) fulfilled the inclusion criteria. All patients were initially evaluated at the emergency room (ER), with a set of tests, part of a specific protocol. Patients with at least one altered exam at initial examination or after six-hour observation received a torso CECT. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (NPV), and likelihood ratio (LH) of the protocol were evaluated. RESULTS: Of 761 patients, 354 (46.5%) received torso CECT because of the positive ER test, with 330 being true positive and 24 being false positive. The remaining 407 patients were negative at ER tests and did not receive torso CECT, showing a significantly (P < 0.001) lower Injury Severity Score (ISS). The positive and negative LH of the protocol to detect torso injuries were respectively 16.5 and 0.01 (overall accuracy of 0.96). CONCLUSIONS: Torso CT can be avoided without adverse clinical outcomes in patients who experience high-energy blunt trauma, are hemodynamically stable, and have normal initial laboratory and imaging tests.
Entities:
Keywords:
Emergency department tests; High-energy trauma; Overtriage; Torso CT scan
Authors: William S Hoff; Michelle Holevar; Kimberly K Nagy; Lisa Patterson; Jeffrey S Young; Abenamar Arrillaga; Michael P Najarian; Carl P Valenziano Journal: J Trauma Date: 2002-09
Authors: James F Holmes; David H Wisner; John P McGahan; William R Mower; Nathan Kuppermann Journal: Ann Emerg Med Date: 2009-05-19 Impact factor: 5.721