CT in Blunt Trauma

There is a lot of literature on the use of full body CT (pan scan) in blunt trauma. Most are retrospective as it is a difficult subject to study. It is important to realize many argue that some positive findings do not need intervention and finding them ultimately does not change outcome. In addition an increase use of CT leads to increase cost and likely to increase of future carcinoma.

Retrospective study from a trauma registry in Germany including 4621 blunt trauma patients of which 1494 patients got whole body CT: The patients who had whole-body CT had a significantly higher injury-severity score. The mean time from trauma room to admission was shorter in the whole body CT group (this has been a common finding in many studies). The authors suggest that integration of whole-body CT is an independent predictor for survival.

Prospective study involving 592 stable neuro intact blunt trauma patients: 120 patients (20.3%) had a change in treatment based on findings on the abdominal CT scan. All of these patients had a normal abdominal exam.

In a prospective study of 443 patients with blunt trauma 284 underwent full body CT. Emergency physicians would have been willing to omit 27% of scans. If these scans were omitted two injuries requiring immediate action would be missed and potentially important injuries would not have been identified during initial harassment in 17% of patients.

These studies are listed in order. The last two studies are worth a look if you question pan scanning patients based on mechanism. The studies arguing against pan CT will be presented later.

Huber-Wagner S, et al, Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009 Apr 25;373(9673):1455-61.

Salim A, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg. 2006 May;141(5):468-73.

Tillou A, et al.  Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 2009 Oct;67(4):779-87.

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