Alexander Gäble1, Julian Hebebrand2, Marco Armbruster2, Fabian Mück3, Maria Berndt4, Bernhard Kumle5, Ulrich Fink6, Stefan Wirth7,8,9,10. 1. Zentrum für bildgebende Diagnostik und interventionelle Therapie, Donau-Isar-Klinikum, Perlasberger Str. 41, 94469, Deggendorf, Deutschland. Alexander.Gaeble@icloud.com. 2. Klinik und Poliklinik für Radiologie, Klinikum der LMU München, München, Deutschland. 3. Zentrum für bildgebende Diagnostik und interventionelle Therapie, Donau-Isar-Klinikum, Perlasberger Str. 41, 94469, Deggendorf, Deutschland. 4. Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. 5. Zentrale Notaufnahme und Aufnahmestation, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland. 6. Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland. 7. Zentrum für bildgebende Diagnostik und interventionelle Therapie, Donau-Isar-Klinikum, Perlasberger Str. 41, 94469, Deggendorf, Deutschland. wirth.online@googlemail.com. 8. Klinik und Poliklinik für Radiologie, Klinikum der LMU München, München, Deutschland. wirth.online@googlemail.com. 9. Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland. wirth.online@googlemail.com. 10. European Society of Emergency Radiology, Wien, Österreich. wirth.online@googlemail.com.
Abstract
CLINICAL ISSUE: The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated. STANDARD RADIOLOGICAL METHODS: Considering severely injured patients with an Injury Severity Score (ISS) ≥16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment. METHODOLOGICAL INNOVATION AND EVALUATION: In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible. PRACTICAL RECOMMENDATIONS: In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".
CLINICAL ISSUE: The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated. STANDARD RADIOLOGICAL METHODS: Considering severely injured patients with an Injury Severity Score (ISS) ≥16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment. METHODOLOGICAL INNOVATION AND EVALUATION: In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible. PRACTICAL RECOMMENDATIONS: In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".
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