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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.
Insights
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.
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.
Abstract:
Trauma remains the leading cause of mortality in the United States for those <45 years of age, and it is the fourth leading cause of death overall. Polytrauma is defined as an injury to at least two body parts, including the head, neck, chest, abdomen, pelvis, or an extremity, with any one or a combination of these injuries being potentially fatal. This document covers imaging of major blunt trauma or polytrauma resulting in multiple organ injuries. Burn injuries, and injuries to pediatric patients are excluded. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
