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ACR Appropriateness Criteria® Major Blunt Trauma: Update 2025.

, James T Lee¹, Marc A Camacho²

¹Panel Chair, University of Kentucky, Lexington, Kentucky; Committee on Emergency Radiology, Commission on General, Small, Emergency and/or Rural Practice.

Journal of the American College of Radiology : JACR

|February 27, 2026

Summary

Major blunt trauma and polytrauma require appropriate imaging for potentially fatal injuries. These guidelines focus on adult imaging, excluding burns and pediatric cases, to ensure timely and effective patient care.

Keywords:

AUC Appropriateness Criteria appropriate use criteria blunt injury fall from height motor vehicle collision polytrauma trauma

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Area of Science:

Emergency Medicine
Radiology
Trauma Surgery

Background:

Trauma is a leading cause of death in the US, particularly for individuals under 45.
Polytrauma involves injuries to at least two major body parts, posing a significant mortality risk.
Effective imaging is crucial for managing multiple organ injuries in major blunt trauma and polytrauma cases.

Purpose of the Study:

To provide evidence-based guidelines for imaging in major blunt trauma and polytrauma.
To outline the methodology for developing appropriateness criteria for imaging procedures.
To support clinical decision-making in the management of severe trauma.

Main Methods:

Systematic analysis of peer-reviewed medical literature.
Adaptation of established evidence evaluation principles like GRADE.
Utilizing the RAND/UCLA Appropriateness Method for procedure evaluation.
Incorporating expert opinion when literature is limited or equivocal.

Main Results:

The document presents imaging guidelines for adult polytrauma and major blunt trauma.
Recommendations are based on a rigorous review of evidence and expert consensus.
Exclusion criteria include burn injuries and pediatric trauma patients.

Conclusions:

These guidelines aim to optimize imaging utilization in severe trauma scenarios.
The methodology ensures recommendations are evidence-based and clinically relevant.
Adherence to these criteria can improve patient outcomes in trauma care.