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Pan computed tomography for blunt polytrauma: Are we doing too many?
G V Oosthuizen1, J L Bruce, W Bekker
1Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa. george.oost@gmail.com.
Summary
Pan computed tomography (CT) scans are valuable in trauma care, influencing management in most cases. Clinically negative scans are crucial for unreliable patients, but selective imaging may suffice for stable individuals.
Area of Science:
- Trauma Imaging
- Radiology
- Emergency Medicine
Background:
- Pan computed tomography (CT) is a standard diagnostic tool for blunt polytrauma patients.
- Concerns exist regarding the cumulative radiation exposure from frequent pan CT scans.
Purpose of the Study:
- To evaluate the utilization of pan CT in a trauma service.
- To determine if scan reduction is feasible without compromising the detection of significant injuries.
Main Methods:
- An audit of all pan CT scans performed over a 12-month period in a metropolitan trauma service.
- Analysis of scan findings and their impact on patient management decisions.
Main Results:
- Pan CT influenced management in 77.1% of cases, identifying injuries in the brain, cervical spine, chest, and abdomen.
- Clinically negative scans were vital in 22.9% of cases, particularly for patients with unreliable clinical assessments (e.g., low GCS, sedation, or distracting injuries).
Conclusions:
- The majority of pan CT scans in this trauma setting are clinically beneficial.
- Clinically negative scans play a critical role in ruling out injuries in unstable patients.
- For patients with a Glasgow Coma Score of 15 and no distracting injuries, clinical assessment and alternative imaging may be appropriate.
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