title: Routine whole body CT of high energy trauma patients leads to excessive radiation exposure.
abstract: BACKGROUND
  Whole body computed tomography (WBCT) is an important adjunct in trauma care, which is often part of standard protocol in initial management of trauma patients. However, WBCT exposes patients to a significant dose of radiation. The use of WBCT was assessed in a modern trauma cohort in Sweden.
  
  
  METHODS
  A two-center retrospective cohort study was performed. All consecutive trauma alert patients at a university hospital (July-December 2008), and a rural county hospital (January 2009- December 2010) were included. Patients were stratified into three groups (high, intermediate and low risk) based on documented suspected injuries at primary survey at the site of accident or at the emergency department. Injury severity score (ISS) was calculated. Case records were reviewed for clinical and radiological findings at the time of trauma, and during a ≥36 months of follow-up period to identify possible missed injuries.
  
  
  RESULTS
  A total of 523 patients were included in the study (university hospital n = 273; rural county hospital n = 250), out of which 475 patients (91.0 %) underwent radiological examinations, 290 patients (55.4 %) underwent WBCT, which identified trauma related findings in 125 patients (43.1 % of those examined). The high-risk group (n = 62) had a mean age of 38.5 years (21.1 SD). Mean ISS was 16.48 (18.14 SD). In this group, WBCT resulted in a positive finding in 38 (74.5 %) patients. In the intermediate-risk group (n = 322; mean age 37.66, 20.24 SD) ISS was 4.42 (6.30 SD). A positive finding on WBCT was found in 87 of the intermediate group patients (44.8 %). The low-risk group (n = 139; mean age 32.5 years; 21.4 SD) had a mean ISS of 0.84 (1.57 SD) with no positive findings on WBCT and no missed injuries in medical records at ≥36 months.
  
  
  CONCLUSIONS
  The risk of developing radiation induced cancer is significant for young people if exposed to relatively high dose radiation as is the case in WBCT. WBCT in high-energy trauma is important for planning of treatment in severely injured patients while it can be questioned in the seemingly not injured where it is used mainly to permit early discharge from the ED.
  
  
  CONCLUSIONS
  Risk stratification criteria could in this retrospective study identify high energy trauma patients not in need of radiological imaging. WBCT in high-energy trauma does not affect patient care if the patient is mentally alert, not intoxicated nor shows signs of other than minor injuries when evaluated by a trauma-team. The risk of missing important traumatic findings in these patients is very low. Observation of the patient with reexamination instead of imaging may be considered in this group of often young patients where radiation dose is an issue.
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. fredrik.linder@surgsci.uu.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Linder
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. kevin.mani@surgsci.uu.se.
authors.forename: Kevin
authors.initials: K
authors.lastname: Mani
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. claes.juhlin@akademiska.se.
authors.forename: Claes
authors.initials: C
authors.lastname: Juhlin
authors.affiliation: Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden. hampus.eklof@radiol.uu.se.
authors.forename: Hampus
authors.initials: H
authors.lastname: Eklöf
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006780:Hospitals, Rural; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069079:Radiation Exposure / Q000517:prevention & control*; D012189:Retrospective Studies; D013548:Sweden; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging; D055815:Young Adult
references.citation: J Trauma Acute Care Surg. 2012 Sep;73(3):573-8; discussion 578-9
references.pmid: 22929486
references.citation: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014 Jun;57(6):673-80
references.pmid: 24838539
references.citation: J Trauma. 2011 Jun;70(6):1362-5
references.pmid: 21817973
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: Patient Saf Surg. 2008 Aug 23;2:20
references.pmid: 18721480
references.citation: West J Emerg Med. 2011 Nov;12(4):496-504
references.pmid: 22224146
references.citation: Eur Radiol. 1998;8(9):1630-8
references.pmid: 9866776
references.citation: Bull Am Coll Surg. 2015 Jan;100(1):61-2
references.pmid: 25626275
references.citation: Am J Surg. 2007 May;193(5):630-4; discussion 634-5
references.pmid: 17434371
references.citation: Acta Chir Belg. 2006 Sep-Oct;106(5):500-7
references.pmid: 17168258
references.citation: Emerg Radiol. 2014 Dec;21(6):571-6
references.pmid: 24838812
references.citation: J Trauma Acute Care Surg. 2012 Feb;72(2):410-5
references.pmid: 22327983
references.citation: Health Syst Transit. 2012;14(5):1-159
references.pmid: 22894859
references.citation: Lakartidningen. 1994 Mar 23;91(12):1191, 1194-6
references.pmid: 8189848