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Early detection of severe injuries after major trauma by immediate total-body CT scouts

•During planning of iTBCT scanning, scouts could be used for detection of specific injuries, such as pneumo- / hemothorax and pelvic fractures.•Further research is needed to support decisions on interventions based on iTBCT scouts alone.•We advise to wait for the complete iTBCT scan results that fol...

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Bibliographic Details
Published in:Injury 2020-01, Vol.51 (1), p.15-19
Main Authors: Treskes, K., Russchen, M.J.A.M., Beenen, L.F.M., de Jong, V.M., Kolkman, S., de Bruin, I.G.J.M., Dijkgraaf, M.G.W., Van Lieshout, E.M.M., Saltzherr, T.P., Goslings, J.C.
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Language:English
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Summary:•During planning of iTBCT scanning, scouts could be used for detection of specific injuries, such as pneumo- / hemothorax and pelvic fractures.•Further research is needed to support decisions on interventions based on iTBCT scouts alone.•We advise to wait for the complete iTBCT scan results that follow relatively shortly after the scouts before decisions on interventions are made. Evaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. All patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Inter-observer agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo- and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. In total 220 patients with a median age of 37 years (IQR 26–59) were selected with a median Injury Severity Score of 18 (IQR 9–27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo- and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%–22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%–100%) and 50% (95%CI 22%–78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%–98%) and 22% (95%CI 4%–60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. iTBCT scouts can be useful for early detection of pneumo- and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2019.08.040