Journal of Trauma & Treatment

CT in Acute Trauma: Observations from a Level One Trauma Centre in Western Australia

Abstract

Hooman Rad, Tristan Cassidy J, Emily O? Halloran and Renee Zellweger

Background: The use of diagnostic imaging in medicine has changed with the advancement of  technology – now faster, more detailed and more available. Advanced Trauma Life Support (ATLS)  provides clear criteria for plain film assessment but the guidance on CT scanning in acute trauma is defined less well and depends upon national guidelines and local protocols. There has been a marked increase in the use of CT across the spectrum of trauma patients. This has paved the advent of multiple scans on admission and Whole-Body CT (WBCT) scans during resuscitation. The question is: Is it truly indicated?
Methods: Over a ten-month period from June 2011 to April 2012, 100 adults admitted to the state trauma unit were randomly selected for prospective data collection. Our primary outcome was mortality and our secondary outcome was identification of a Significant Injury (SI) on CT scanning. A significant injury was defined as; any finding on CT which resulted in a change of management.
Results: There were 100 patients recruited for prospective data collection during ten months, from June 2011 and April 2012. The study population was predominantly males (79%), from the metropolitan area, involved in motor vehicle accidents. Mortality rate was 0% at three months follow up. The prevalence of significant injury demonstrated on WBCT and regional body CT appear equivocal, with the exception of CT pelvis.
Conclusion: In the acute trauma setting CT of head and cervical spine delivers valuable clinical information in a timely and low cost manner. With consideration for cost and long term implications on patient safety, we believe that further scanning of the Chest/Abdomen/Pelvis should be clinically driven. We propose that continued careful history taking and physical examination remain a key component to assessing the indication for CT Chest/Abdomen/Pelvis in acute trauma patients.