20
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Whole-body computed tomography in trauma patients: optimization of the patient scanning position significantly shortens examination time while maintaining diagnostic image quality

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The study was conducted to compare examination time and artifact vulnerability of whole-body computed tomographies (wbCTs) for trauma patients using conventional or optimized patient positioning.

          Patients and methods

          Examination time was measured in 100 patients scanned with conventional protocol (Group A: arms positioned alongside the body for head and neck imaging and over the head for trunk imaging) and 100 patients scanned with optimized protocol (Group B: arms flexed on a chest pillow without repositioning). Additionally, influence of two different scanning protocols on image quality in the most relevant body regions was assessed by two blinded readers.

          Results

          Total wbCT duration was about 35% or 3:46 min shorter in B than in A. Artifacts in aorta (27 vs 6%), liver (40 vs 8%) and spleen (27 vs 5%) occurred significantly more often in B than in A. No incident of non-diagnostic image quality was reported, and no significant differences for lungs and spine were found.

          Conclusion

          An optimized wbCT positioning protocol for trauma patients allows a significant reduction of examination time while still maintaining diagnostic image quality.

          Related collections

          Most cited references 19

          • Record: found
          • Abstract: found
          • Article: not found

          Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.

          The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not. In a retrospective, multicentre study, we used the data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardised mortality ratio (SMR, ratio of recorded to expected mortality) for 4621 patients with blunt trauma given whole-body or non-whole-body CT. 1494 (32%) of 4621 patients were given whole-body CT. Mean age was 42.6 years (SD 20.7), 3364 (73%) were men, and mean injury-severity score was 29.7 (13.0). SMR based on TRISS was 0.745 (95% CI 0.633-0.859) for patients given whole-body CT versus 1.023 (0.909-1.137) for those given non-whole-body CT (p<0.001). SMR based on the RISC score was 0.865 (0.774-0.956) for patients given whole-body CT versus 1.034 (0.959-1.109) for those given non-whole-body CT (p=0.017). The relative reduction in mortality based on TRISS was 25% (14-37) versus 13% (4-23) based on RISC score. Multivariate adjustment for hospital level, year of trauma, and potential centre effects confirmed that whole-body CT is an independent predictor for survival (p
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Increasing utilization of computed tomography in the adult emergency department, 2000-2005.

            This study aims to characterize changes in computed tomography (CT) utilization in the adult emergency department (ED) over a 5-year period. CT scans ordered on adult ED patients from July 2000 to July 2005 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. ED patient volume and triage acuity scores were determined. Triage acuity scores are used to determine the severity of a patient's illness or injury and the need for immediate evaluation and treatment. There were 46,553 CT scans performed on 27,625 adult patients in the ED during the study period. During this same period, 194,622 adult patients were evaluated in the ED. From 2000 to 2005, the adult emergency department patient volume increased by 13% while triage acuity remained stable. During this same period, head CT increased by 51%, cervical spine CT by 463%, chest CT by 226%, abdominal CT by 72%, and miscellaneous CT by 132%. Although increases were generally greater for patients over age 40, the increase in those less than 40 years was also substantial. Of the 4,320 individual patients who underwent chest CT, 83 (2%) had chest CT on three or more separate ED visits. Of 10,960 patients undergoing abdominal CT, 406 (4%) had abdominal CT on three or more separate ED visits. ED CT utilization has increased at a rate far exceeding the growth in ED patient volume. This presumably reflects the improved utility of CT in diagnosing serious pathology, its increased availability, and a desire on the part of physicians for diagnostic certainty. Whether this increase in utilization results in improved patient outcomes is at present unclear and deserves additional study.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study

              Background The current common and dogmatic opinion is that whole-body computed tomography (WBCT) should not be performed in major trauma patients in shock. We aimed to assess whether WBCT during trauma-room treatment has any effect on the mortality of severely injured patients in shock. Methods In a retrospective multicenter cohort study involving 16719 adult blunt major trauma patients we compared the survival of patients who were in moderate, severe or no shock (systolic blood pressure 90–110, 110 mmHg) at hospital admission and who received WBCT during resuscitation to those who did not. Using data derived from the 2002–2009 version of TraumaRegister®, we determined the observed and predicted mortality and calculated the standardized mortality ratio (SMR) as well as logistic regressions. Findings 9233 (55.2%) of the 16719 patients received WBCT. The mean injury severity score was 28.8±12.1. The overall mortality rate was 17.4% (SMR  = 0.85, 95%CI 0.81–0.89) for patients with WBCT and 21.4% (SMR = 0.98, 95%CI 0.94–1.02) for those without WBCT (p<0.001). 4280 (25.6%) patients were in moderate shock and 1821 (10.9%) in severe shock. The mortality rate for patients in moderate shock with WBCT was 18.1% (SMR 0.85, CI95% 0.78–0.93) compared to 22.6% (SMR 1.03, CI95% 0.94–1.12) to those without WBCT (p<0.001, p = 0.002 for the SMRs). The mortality rate for patients in severe shock with WBCT was 42.1% (SMR 0.99, CI95% 0.92–1.06) compared to 54.9% (SMR 1.10, CI95% 1.02–1.16) to those without WBCT (p<0.001, p = 0.049 for the SMRs). Adjusted logistic regression analyses showed that WBCT is an independent predictor for survival that significantly increases the chance of survival in patients in moderate shock (OR = 0.73; 95%CI 0.60–0.90, p = 0.002) as well as in severe shock (OR = 0.67; 95%CI 0.52–0.88, p = 0.004). The number needed to scan related to survival was 35 for all patients, 26 for those in moderate shock and 20 for those in severe shock. Conclusions WBCT during trauma resuscitation significantly increased the survival in haemodynamically stable as well as in haemodynamically unstable major trauma patients. Thus, the application of WBCT in haemodynamically unstable severely injured patients seems to be safe, feasible and justified if performed quickly within a well-structured environment and by a well-organized trauma team.
                Bookmark

                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                07 May 2018
                : 14
                : 849-859
                Affiliations
                [1 ]Department of Radiology, University Hospital of Cologne, Cologne, Germany
                [2 ]Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
                [3 ]Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
                [4 ]Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
                Author notes
                Correspondence: De-Hua Chang, Department of Radiology, University Hospital of Cologne, Kerpener-Str. 62, Cologne 50973, Germany, Tel +49 221 478 96023, Fax +49 221 478 82384, Email de-hua.chang@ 123456uk-koeln.de
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-849
                10.2147/TCRM.S162074
                5944460
                © 2018 Hickethier et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                ct scan, polytrauma, acute care, time requirement, positioning

                Comments

                Comment on this article