Whole-body CT scans can prove but not exclude trauma injuries

In the assessment of severe trauma, single-pass whole-body CT can prove but not definitively exclude the presence of injuries, according to a study recently published in the Canadian Medical Association Journal.

The study also noted that for optimal results, the scans should be performed later than 30 minutes after admission to the emergency department.

“We found that single-pass whole-body [CT] is very effective (or specific) at determining where there is injured tissue but is variable in excluding injuries in patients with suspected blunt trauma,” study author Dirk Stengel, MD, PhD, stated in a Canadian Medical Association Journal news release. “Screening tests in trauma are intended to immediately detect life-threatening injuries. Given this premise, high specificity — meaning that a positive test result shows injury — makes pan-scanning a valuable tool for priority-oriented treatment.”

The authors investigated the imaging results of 982 patients with 1,756 injuries between July 2006 and December 2008, according to the study abstract. The results were compared to a synopsis of hospital charts, subsequent imaging and interventional procedures.

The authors found initial scan sensitivity to be highest in thoracic injuries (86.7%) and lowest in facial injuries (79.6%), with the highest specificity being found in pelvic injuries (99.8%) and the lowest specificity being found in abdominal injuries (97.5%). Seventy-seven scans (7.8%) were found to be unnecessary, the release noted, adding selective scanning would have been sufficient in these cases.

“The pan-scan performs best 30 minutes after admission because the sensitivity of the scan increases after this interval,” Stengel stated. “The transfusion of fluids, blood, plasma and emergency interventions to stabilize circulation will restore organ perfusion, and make bleedings and hematomas visible on CT scans.”

The release also noted that health care teams should verify negative results to rule out false-negative results with additional clinical observation, follow-up examination or further imaging.

“Pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and should not replace close monitoring and clinical follow-up of patients with major trauma,” the authors wrote in the study.

Reference:
Stengel D, Ottersbach C, Matthes G, et al. Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma. Can Med Assoc J. 2012. doi: 10.1503/cmaj.111420

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