title: Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma.
abstract: BACKGROUND
  Contrast-enhanced whole-body computed tomography (also called "pan-scanning") is considered to be a conclusive diagnostic tool for major trauma. We sought to determine the accuracy of this method, focusing on the reliability of negative results.
  
  
  METHODS
  Between July 2006 and December 2008, a total of 982 patients with suspected severe injuries underwent single-pass pan-scanning at a metropolitan trauma centre. The findings of the scan were independently evaluated by two reviewers who analyzed the injuries to five body regions and compared the results to a synopsis of hospital charts, subsequent imaging and interventional procedures. We calculated the sensitivity and specificity of the pan-scan for each body region, and we assessed the residual risk of missed injuries that required surgery or critical care.
  
  
  RESULTS
  A total of 1756 injuries were detected in the 982 patients scanned. Of these, 360 patients had an Injury Severity Score greater than 15. The median length of follow-up was 39 (interquartile range 7-490) days, and 474 patients underwent a definitive reference test. The sensitivity of the initial pan-scan was 84.6% for head and neck injuries, 79.6% for facial injuries, 86.7% for thoracic injuries, 85.7% for abdominal injuries and 86.2% for pelvic injuries. Specificity was 98.9% for head and neck injuries, 99.1% for facial injuries, 98.9% for thoracic injuries, 97.5% for abdominal injuries and 99.8% for pelvic injuries. In total, 62 patients had 70 missed injuries, indicating a residual risk of 6.3% (95% confidence interval 4.9%-8.0%).
  
  
  CONCLUSIONS
  We found that the positive results of trauma pan-scans are conclusive but negative results require subsequent confirmation. The pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and they should not replace close monitoring and clinical follow-up of patients with major trauma.
authors.affiliation: Centre for Clinical Research, Unfall krankenhaus Berlin, Berlin, Germany. dirk.stengel@ukb.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Stengel
authors.forename: Caspar
authors.initials: C
authors.lastname: Ottersbach
authors.forename: Gerrit
authors.initials: G
authors.lastname: Matthes
authors.forename: Moritz
authors.initials: M
authors.lastname: Weigeldt
authors.forename: Simon
authors.initials: S
authors.lastname: Grundei
authors.forename: Grit
authors.initials: G
authors.lastname: Rademacher
authors.forename: Anja
authors.initials: A
authors.lastname: Tittel
authors.forename: Sven
authors.initials: S
authors.lastname: Mutze
authors.forename: Axel
authors.initials: A
authors.lastname: Ekkernkamp
authors.forename: Matthias
authors.initials: M
authors.lastname: Frank
authors.forename: Uli
authors.initials: U
authors.lastname: Schmucker
authors.forename: Julia
authors.initials: J
authors.lastname: Seifert
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014193:Trauma Centers; D051598:Whole Body Imaging / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*