Whole-body CT indications in emergency medicine trauma patients

Whole-body computerized tomography (CT) scan designed as early diagnosis of traumatic injuries and prevention of unnoticeable injuries. Using Whole-body CT in trauma patients still controversial, there is no consensus on indications.

The aim of this study is to clarify indications and cut-off levels in vital parameters in trauma patients who undergo Whole-body CT to prevent unnecessary or negative scans.

We evaluated patients with trauma who applied our emergency service between 01.09.2019 and 30.09.2020. Patients above 18 years old with Whole-body CT scan included. Whole-body CT reports were evaluated according to five categories; cranial-face, vertebra, thorax, abdomen, pelvis-bone.

The review of whole-body CT reports, 46.3% detected normally. But, 53.7% of patients had injuries at least one zone, 23.3% at least two zones, and 7.4% at least three zones respectively. Prediction criteria of Whole-body CT for the patients with two or three zones injury, systolic blood pressure (SBP) ≤100 mm Hg, Glasgow coma scale (GCS) <15, and free fluid in Focused Assessment with Sonography for Trauma (FAST) were independent variables in regression analysis. When patients had at least one of three variables, the negative predictive value of whole-body CT was 96% for three zones and 91% for two zones.

The cut-off values of GCS <15 and SBP ≤100 mm Hg were useful vital parameters in making whole-body CT decisions in trauma patients in the emergency service. Also, free fluid detection in FAST can be used for whole-body CT decisions.