title: Routine versus selective multidetector-row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management.
abstract: BACKGROUND
  This study was performed to determine the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective multidetector-row computed tomography (MDCT) findings in blunt trauma patients.
  
  
  METHODS
  For this study, 50 patients were randomly selected from a customized database that was originally used to compare a diagnostic algorithm with a selective use of MDCT with an algorithm with routine MDCT of the spine, chest, and abdomen within the same population. In all 50 patients, routine MDCT found additional diagnoses as compared with the selective MDCT algorithm. Of all patients, paper cases were created with detailed information on clinical parameters, findings by physical examination, and radiologic findings. The cases were independently presented to three different trauma surgeons. First, the surgeons were asked for their treatment plan based upon diagnoses found by physical examination, conventional radiography, and selective MDCT alone. Subsequently they were asked for their treatment plan with knowledge of the injuries additionally found by routine MDCT. This procedure was repeated after 3 months. The agreement between and within surgeons was determined for the change of patient management because of additional findings by routine MDCT.
  
  
  RESULTS
  The agreement on the influence of routine MDCT findings on patient management between surgeons was moderate ([kappa] = 0.46) in the first procedure and substantial in the second ([kappa] = 0.67). The agreement within surgeons ranged from moderate ([kappa] = 0.60) to excellent ([kappa] = 0.87).
  
  
  CONCLUSIONS
  All surgeons agreed that the traumatic injuries additionally found by routine MDCT, frequently resulted in a change of treatment plan. There was a moderate-to-excellent agreement between and within surgeons that these additional findings resulted in a change of treatment plan.
authors.affiliation: Department of Surgery and Trauma, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Deunk
authors.forename: Monique
authors.initials: M
authors.lastname: Brink
authors.forename: Helena M
authors.initials: HM
authors.lastname: Dekker
authors.forename: Digna R
authors.initials: DR
authors.lastname: Kool
authors.forename: Johan G
authors.initials: JG
authors.lastname: Blickman
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery