Role of Multidetector CT in Evaluation of Polytrauma Patients

Amit Nandan Dhar Dwivedi

Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Banaras, India.

DOI: 10.4236/ojem.2014.23009                

Abstract

Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.

Keywords

Polytrauma, Whole Body Multidetector CT, Major Vascular Injuries, Major Visceral Injuries

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Hilbert, P., zur Nieden, K., Hofmann, G.O., Hoeller, I., Koch, R. and Stuttmann, R. (2007) New Aspects in the Emergency Room Management of Critically Injured Patients: A Multi-Slice CT-Oriented Care Algorithm. Injury, 38, 552- 558. http://dx.doi.org/10.1016/j.injury.2006.12.023
[2]	Huber-Wagner, S., Lefering, R., Qvick, L.M., K?rner, M., Kay, M.V., Pfeifer, K.J., et al. (2009) Effect of Whole-Body CT during Trauma Resuscitation on Survival: A Retrospective, Multicentre Study. The Lancet, 373, 1455-1461. http://dx.doi.org/10.1016/S0140-6736(09)60232-4
[3]	Philipp, M.O., Kubin, K., Hormann, M. and Metz, V.M. (2003) Radiological Emergency Room Management with Emphasis on Multidetector-Row CT. European Journal of Radiology, 48, 2-4. http://dx.doi.org/10.1016/S0720-048X(03)00206-7
[4]	The Royal College of Radiologists (2011) Standards of Practice and Guidance for Trauma Radiology in Severely Injured Patients. The Royal College of Radiologists, London.
[5]	Karlo, C., Gnannt, R., Frauenfelder, T., Leschka, S., Brüesch, M., Wanner, G.A., et al. (2011) Whole-Body CT in Polytrauma Patients: Effect of Arm Positioning on Thoracic and Abdominal Image Quality. Emergency Radiology, 4, 285-293. http://dx.doi.org/10.1007/s10140-011-0948-5
[6]	Dreizin, D. and Munera, F. (2012) Blunt Polytrauma: Evaluation with 64-Section Whole-Body CT Angiography. RadioGraphics, 32, 609-631. http://dx.doi.org/10.1148/rg.323115099
[7]	Foster, B.R., Anderson, S.W., Uyeda, J.W., Brooks, J.G. and Soto, J.A. (2011) Integration of 64-Detector Lower Extremity CT Angiography into Whole-Body Trauma Imaging: Feasibility and Early Experience. Radiology, 261, 787- 795. http://dx.doi.org/10.1148/radiol.11100604
[8]	Chokshi, F.H., Munera, F., Rivas, L.A., Henry, R.P. and Quencer, R.M. (2011) 64-MDCT Angiography of Blunt Vascular Injuries of the Neck. American Journal of Roentgenology, 196, W309-W315. http://dx.doi.org/10.2214/AJR.10.4548
[9]	Bae, K.T. (2010) Intravenous Contrast Medium Administration and Scan Timing at CT: Considerations and Approaches. Radiology, 256, 32-61. http://dx.doi.org/10.1148/radiol.10090908
[10]	Wurmb, T.E., Frühwald, P., Hopfner, W., Keil, T., Kredel, M., Brederlau, J., et al. (2009) Whole-Body Multislice Computed Tomography as the First Line Diagnostic Tool in Patients with Multiple Injuries: The Focus on Time. Journal of Trauma-Injury Infection & Critical Care, 66, 658-665. http://dx.doi.org/10.1097/TA.0b013e31817de3f4
[11]	Houshian, S., Larsen, M.S. and Holm, C. (2002) Missed Injuries in a Level I Trauma Centre. Journal of Trauma-Injury Infection & Critical Care, 52, 715-719. http://dx.doi.org/10.1097/00005373-200204000-00018
[12]	Rieger, M., Czermak, B., El Attal, R., Sumann, G., Jaschke, W. and Freund, M. (2009) Initial Clinical Experience with a 64-MDCT Whole-Body Scanner in an Emergency Department: Better Time Management and Diagnostic Quality? Journal of Trauma-Injury Infection & Critical Care, 66, 648-657. http://dx.doi.org/10.1097/TA.0b013e31816275f3
[13]	McCollough, C.H. (2008) CT Dose: How to Measure, How to Reduce. Health Physics, 95, 508-517. http://dx.doi.org/10.1097/01.HP.0000326343.35884.03
[14]	Hall, E.J. and Brenner, D.J. (2008) Cancer Risks from Diagnostic Radiology. British Journal of Radiology, 81, 362- 378. http://dx.doi.org/10.1259/bjr/01948454
[15]	Huang, B., Law, M.W. and Khong, P.L. (2009) Whole-Body PET/CT Scanning: Estimation of Radiation Dose and Cancer Risk. Radiology, 251, 166-174. http://dx.doi.org/10.1148/radiol.2511081300
[16]	Sun, Z., Ng, K.H. and Vijayananthan, A. (2010) Is Utilisation of Computed Tomography Justified in Clinical Practice? Part I: Application in the Emergency Department. Singapore Medical Journal, 51, 200-206.
[17]	Banerjee, P., Rudra, S., Ghosh, M. and Panose, P. (2013) CT Scans in Primary Survey for Polytrauma Patients. Advances in Computed Tomography, 2, 46-51. http://dx.doi.org/10.4236/act.2013.22009
[18]	Hessmann, M.H., Hofmann, A., Kreitner, K.F., Lott, C. and Rommens, P.M. (2006) The Benefit of Multislice CT in the Emergency Room Management of Polytraumatized Patients. Acta Chirurgica Belgica, 106, 500-507.