Whole-Body CT Scans Can Verify But Not Rule Out Injuries in Patients with Major Trauma

For evaluating severe trauma, single-pass whole-body computed tomography (CT) imaging can confirm but not conclusively rule out the presence of injuries and should be performed later than 30 minutes after admission to an emergency department for optimal outcomes, according to a recent study.

The study’s findings were published ahead of print March 5, 2012, in the Canadian Medical Association Journal (CMAJ). Traumatic injury, caused by major traffic collisions or a fall from a height, for example, has a significant impact on health care costs, illness, and death. In North America and Europe, it is one of the top 10 causes of disease burden. The Canadian National Trauma Registry, which contains data from eight of Canada’s 10 provinces, registered 14 065 major injuries between 2008 and 2009.

“Recognize first what kills first” is the adage of imaging during the resuscitation period in patients with major trauma. Whole-body CT scanning has been used since the late 1990s to speed injury diagnosis, but there has been criticism that patients are being overexposed to radiation with increasing and general use. The reliability of positive and negative findings of this promising diagnostic application has not been determined to date.

German researchers conducted a study to determine the effectiveness of whole-body or pan-scan imaging in identifying injuries in various parts of the body in trauma patients. They looked at data from 982 trauma patients who had been immediately transferred to the emergency department at the Unfallkrankenhaus Berlin (Berlin, Germany), a metropolitan trauma center, after injury between July 2006 and November 2008.

The team discovered that 360 patients (36.7%) were diagnosed with multiple trauma; 77 (7.8%) of pan-scans were found to be unnecessary, and selective scanning would have been adequate in these cases. In 62 patients (6.3%), the pan-scan missed injuries that required monitoring in the intensive care unit or surgical treatment.

“We found that single-pass whole-body computed tomography is very effective (or specific) at determining where there is injured tissue but is variable in excluding injuries in patients with suspected blunt trauma,” stated lead author Dr. Dirk Stengel, Center for Clinical Research, Unfallkrankenhaus Berlin and Ernst Moritz Arndt University Medical Center. “Screening tests in trauma are intended to immediately detect life-threatening injuries. Given this premise, high specificity--meaning that a positive test result shows injury--makes pan-scanning a valuable tool for priority-oriented treatment.”

However, most scans are performed too early and may miss significant injuries to organs. “The pan-scan performs best 30 minutes after admission, because the sensitivity of the scan increases after this interval,” stated Dr. Stengel. “The transfusion of fluids, blood, plasma, and emergency interventions to stabilize circulation will restore organ perfusion, and make bleedings and hematomas visible on CT scans.”

Healthcare teams should verify negative results to rule out false-negative results with further clinical observation, follow-up examination, or additional imaging, according to the researchers. “Pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and should not replace close monitoring and clinical follow-up of patients with major trauma,” concluded the authors.

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Unfallkrankenhaus Berlin