title: Clinical Judgment Is Not Reliable for Reducing Whole-body Computed Tomography Scanning after Isolated High-energy Blunt Trauma.
abstract: The purpose of this study was to test the diagnostic performance of clinical judgment for the prediction of a significant injury with whole-body computed tomography scanning after high-energy trauma.
  
  
  
  The authors conducted an observational prospective study in a single level-I trauma center. Adult patients were included if they had an isolated high-energy injury. Senior trauma leaders were asked to make a clinical judgment regarding the likelihood of a significant injury before performance of a whole-body computed tomography scan. Clinical judgments were recorded using a probability diagnosis scale. The primary endpoint was the diagnosis of a serious-to-critical lesion on the whole-body computed tomography scan. Diagnostic performance was assessed using receiver operating characteristic analysis.
  
  
  
  Of the 354 included patients, 127 patients (36%) had at least one injury classified as abbreviated injury score greater than or equal to 3. The area under the receiver operating characteristic curve of the clinical judgment to predict a serious-to-critical lesion was 0.70 (95% CI, 0.64 to 0.75%). The sensitivity of the clinical judgment was 82% (95% CI, 74 to 88%), and the specificity was 49% (95% CI, 42 to 55%). No patient with a strict negative clinical examination had a severe lesion (n = 19 patients). The sensitivity of the clinical examination was 100% (95% CI, 97 to 100%) and its specificity was 8% (95% CI, 5 to 13%).
  
  
  
  Clinical judgment alone is not sufficient to reduce whole-body computed tomography scan use. In patients with a strictly normal physical examination, whole-body computed tomography scanning might be avoided, but this result deserves additional study in larger and more diverse populations of trauma patients.
authors.affiliation: From the Grenoble Alpes Trauma Center, Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France (T.M., J-F.P., P.B.); Université Grenoble Alpes, Grenoble, France (T.M., V.B., J-L.B., G.F., J-F.P., P.B.); INSERM U1216, Grenoble, France (T.M., J-F.P., P.B.); Département de Médecine d'Urgence, CHU Grenoble Alpes, Grenoble, France (V.B., L.S.); Pôle Recherche, CHU Grenoble Alpes, Grenoble, France (J-L.B.); Pole Imagerie, CHU Grenoble Alpes, Grenoble, France (G.F., F.T.); Divisions of Trauma Anesthesiology and Critical Care Medicine, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, Maryland (S.M.G.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Mistral
authors.forename: Vivien
authors.initials: V
authors.lastname: Brenckmann
authors.forename: Laurence
authors.initials: L
authors.lastname: Sanders
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ferretti
authors.forename: Frederic
authors.initials: F
authors.lastname: Thony
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Galvagno
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010808:Physical Examination / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging