Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study

Trauma and 'Whole' Body Computed Tomography: Role, Protocols, Appropriateness, and Evidence to Support its Use and When

Imaging plays a crucial role in the immediate evaluation of the trauma patient, particularly using multi-detector computed tomography (CT), and especially in moderately to severely injured trauma patients. There are specific areas of relative consensus, while other aspects of whole-body computed tomography (WB-CT) use remain controversial and are subject to opinion/debate based on the current literature. Even a few hours of a delayed diagnosis may result in a detrimental outcome for the patient. One must utilize all the tools available to enhance the interpretation of images. It is also important to recognize imaging pitfalls and artifacts to avoid unnecessary intervention.

Investigating the Potential Overuse of Pan-Computed Tomography (PanCT) Examinations in Trauma Cases in Emergency Departments

Background and Objectives: The increasing use of whole-body computed tomography (WBCT) examinations, also known as panCT, in emergency departments for trauma patients has raised concerns about potential overuse and the associated risk of unnecessary radiation exposure. The purpose of this study was to examine the utilization patterns and findings of panCT scans performed over one year at a major academic hospital. Materials and Methods: This retrospective cohort study included 531 stable trauma adult patients who underwent panCT scans in 2023. De-identified data for each patient, including the radiology report, age, gender, and total dose-length product (DLP) of the panCT scan, were retrieved and reviewed. Radiology reports were classified based on the findings as negative (no acute traumatic injuries) or positive, with positive reports further subclassified based on injury location. Injury severity scores (ISS) were also calculated based on the findings of the radiology reports. Statistical analysis was performed using the Python programming language to assess any association between the independent variables (age and gender) and the dependent variable (report findings: negative or positive). Results: About 57% (n = 303) of the panCT scans included in the analysis were negative. The chi-squared test and logistic regression revealed a significant association between age and report finding (negative or positive), while no association with gender was found. One-third of positive cases (n = 72) had injuries only in the head and neck (H&N) region, and another one-third (n = 72) had injuries only in chest-abdomen-pelvis (CAP) region. Most cases (n = 373; 70%) had an ISS between 1 and 8, which is a mild score. Conclusions: This study showed a high rate of negative panCT scans, suggesting potential overuse of panCT. The study results highlight the need for more selective CT imaging approaches in emergency settings. Following evidence-based guidelines and decision-support tools could promote appropriate utilization of panCT scans, reducing unnecessary radiation exposure while ensuring that high-risk patients in emergency setting receive appropriate imaging.

Major trauma with only dynamic criteria: is the routine use of whole-body CT as a first level examination justified?

PURPOSE

Risks and benefits of systematic use of whole-body CT (WBCT) in patients with major trauma when no injury is clinically suspected is still subject of controversy. WBCT allows early identification of potentially evolving lesions, but exposes patients to the risk of high radiation dose and iodine contrast agent. The study aimed to assess if WBCT could be avoided in trauma patients with negative clinical examination.

MATERIALS AND METHODS

This retrospective study included polytrauma patients admitted to the Emergency Department in a six-month period, who had undergone a WBCT scan for major dynamic criteria, with hemodynamic stability, absence of clinical and medical risk factors for major trauma. The patients (n = 233) were divided into two groups according to the absence (n = 152) or presence (n = 81) of clinical suspicion of organ injury. The WBCT results were classified as negative, positive for minor and positive for major lesions.

RESULTS

The average patient age was 44 years. CT scans were completely negative in 111 (47.6%) patients, whose 104 (93.7%) were in the negative clinic group. 122 (52.4%) CT scans were positive, 69 (56.6%) for minor lesions and 53 (43.4%) for major lesions. Among the 48 (39.3%) positive CT scans in patients with negative clinic, only 5 (10.4%) were positive for major lesions. We found a significant difference in the frequency of injuries between the clinically negative and clinically positive patient groups (p < 0.001).

CONCLUSION

A thorough clinical examination associated with a primary radiological evaluation may represent a valid diagnostic approach for trauma with only major dynamic criteria to limit the use of WBCT.