Initial imaging assessment of severe blunt trauma.
OBJECTIVE
Total body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study.


METHODS
Prospective study of a cohort in a level 1 trauma centre of an university teaching hospital.


METHODS
400 patients with severe blunt trauma. Within 30 min of arrival in the hospital, these patients underwent a rapid imaging assessment at the bedside, including chest and pelvic X-ray, and an abdominal ultrasonography. The decision taken for each imaging technique (chest drainage or thoracotomy, pelvic angiography, and laparotomy, respectively) was judged as appropriate or inappropriate.


RESULTS
Emergency chest drainage or thoracotomy was performed in 78 cases (78 appropriate), pelvic angiography in 8 cases (5 appropriate) and immediate laparotomy in 48 cases (47 appropriate). Emergency treatment was decided in 108 patients, and the decisions were considered appropriate in 392 (98%, 95% CI: 97%-99%) cases. Three variables (heart rate, systolic arterial pressure and Glasgow Coma Scale) were independent predictors of the need for an emergency decision, but among patients who had none of these criteria, 16% required an emergency decision.


CONCLUSIONS
A simple and rapid initial imaging assessment enabled appropriate emergency decisions before further imaging assessment was performed. We recommend that every patient with severe blunt trauma receive this initial assessment.
Peytel
E
E
Département d'anesthésie-réanimation, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 Boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Menegaux
F
F
Cluzel
P
P
Langeron
O
O
Coriat
P
P
Riou
B
B
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*