[The value of computed tomography in the early treatment of seriously injured patients].
BACKGROUND
The availability of newer, faster computed tomography (CT) technology has engendered discussion about whole-body CT-scanning for primary radiological diagnostics of seriously injured patients.


METHODS
Within a quality management system, the scaled, priority-oriented scheme of conventional radiological and CT-diagnostics used in each institution was analysed and compared with the possible benefit of whole-body CT-scanning. Every patient with severe trauma admitted directly from the scene of an accident, underwent basic radiological and sonographic diagnostics in the emergency room (ER). According to the findings, patients in a stable vital condition had CT-scans when indicated by the guidelines of the particular institution.


RESULTS
From 5/1998 until 12/2000, a total of 832 patients were treated in the ER. Of those, 480 patients (average ISS 20) were admitted directly from the scene of the accident. Basic radiological - sonographic diagnostics (radiographs of cervical spine, chest, and abdomen, as well as abdominal sonography) took 15+/-8 min. Twenty-two (5%) of the patients in hemorrhagic shock needed emergency operations after 57+/-43 min. The remaining patients underwent further radiological diagnostics (spine, extremities etc.) after 44+/-27 min. In 79% (379) of patients, CT was indicated. Cranial CT for traumatic brain injury prevailed clearly with 74% of cases. Spine (24%), chest (18%), abdomen (5%) and pelvis (5%) were indicated comparatively less frequently. The incidence of delayed diagnoses (after ICU-admission) was 4% (22). In 2% (nine) of patients the lesions possibly could have been detected by a primary CT-scan. In the three cases with thoracic lesions, there was a deviation from the indication guidelines for thoracic CT as normally used in the institution. There were three cases of delayed diagnoses in both the cerebral (small contusion haematomas) region and the abdominal region. The abdominal lesions were detected by sonographic control examinations. No patient died because of a delayed diagnosis. The average X-ray dose was five times lower with the scaled diagnostic management comprising indicated CT when compared to the doses calculated for routine whole-body CT.


CONCLUSIONS
While 74% of patients had cranial CT, only 25% needed CT for the trunk regions. Delayed diagnoses were rare and without severe consequences for the patient. Considering the five times higher X-ray doses combined with the possible time loss in patients with unstable conditions, primary whole-body CT-scanning should not be performed routinely when serious injury is suspected.
Ruchholtz
S
S
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Essen, Germany. steffen.ruchholtz@uni-essen.de
Waydhas
C
C
Schroeder
T
T
Piepenbrink
K
K
Kühl
H
H
Nast-Kolb
D
D
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D002423:Cause of Death; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed