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Re: comparison of clinically suspected injuries detected at whole-body CT in suspected multi-trauma victims
Clinical Radiology 71 (2016) 399e401
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: comparison of clinically suspected injuries detected at whole-body CT in suspected multi-trauma victims SirdShannon et al.1 found that 32% of trauma wholebody computed tomography (WBCT) examinations were completely negative and 35% demonstrated injury in one body area only. This raises important questions around the liberality with which WBCT is requested; however, we feel that a 4% rate for clinically unexpected findings is considerably below the frequency suggested in the existing literature, and that this may be due to the method used. Three large studies, of which only the paper by Salim et al.2 was quoted by Shannon et al., describe “clinically unexpected finding” rates of between 17% and 38%,2e4 leading to a change in management in a high proportion of cases. These papers had more robust criteria for classifying a “clinically expected” injury. Shannon et al. grouped injuries into four regions, one of which included all of abdomen, pelvis, and lumbar spine as a single “body area”, in which clinicians could have placed a single “tick” to express concern. Injury to the thoracolumbar junction, lower lumbar spine, multiple internal organs, and pelvis would thus be classified as a single area and unsuspected damage to any of these would not be counted as an unexpected finding. This discrepancy between Shannon et al. and the literature is important, as clinically unexpected findings underpin the reasoning behind performing WBCT and its associated overall reduced mortality.5
References 1. Shannon L, Peachey T, Skipper N, et al. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multitrauma victims. Clin Radiol 2015;70(11):1205e11. 2. Salim A, Sangthong B, Martin M, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006;141(5):468e73.
DOI of original article: http://dx.doi.org/10.1016/j.crad.2015.12.011.
3. Tillou A, Gupta M, Baraff LJ, et al. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma 2009;67(4):779e87. 4. Self ML, Blake AM, Whitley M, et al. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. Am J Surg 2003;186(6):609e13. 5. Caputo ND, Stahmer C, Lim G, et al. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014;77:534e9.
D.F.W. Maclean*, M. Sampson University Hospital Southampton, Southampton, UK * Guarantor and correspondent. E-mail address: [email protected] (D.F.W. Maclean) http://dx.doi.org/10.1016/j.crad.2015.11.022 Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved..
Re: comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. A reply SirdWe are pleased our article has generated some interest and welcome the opportunity to respond to the comments of Maclean and Sampson.1 In our study, we grouped injuries into body areas based on the anatomical regions covered in each part of a wholebody computed tomography (WBCT) examination (head, neck, thorax, abdomen/pelvis). This was to evaluate whether WBCT would pick up unexpected injuries that would be missed on selective scans of specific body regions. Separating the lumbar spine from abdominal viscera or the lungs from the mediastinum does not make practical sense
DOI of original article: http://dx.doi.org/10.1016/j.crad.2015.11.022.
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: comparison of clinically suspected injuries detected at whole-body CT in suspected multi-trauma victims SirdShannon et al.1 found that 32% of trauma wholebody computed tomography (WBCT) examinations were completely negative and 35% demonstrated injury in one body area only. This raises important questions around the liberality with which WBCT is requested; however, we feel that a 4% rate for clinically unexpected findings is considerably below the frequency suggested in the existing literature, and that this may be due to the method used. Three large studies, of which only the paper by Salim et al.2 was quoted by Shannon et al., describe “clinically unexpected finding” rates of between 17% and 38%,2e4 leading to a change in management in a high proportion of cases. These papers had more robust criteria for classifying a “clinically expected” injury. Shannon et al. grouped injuries into four regions, one of which included all of abdomen, pelvis, and lumbar spine as a single “body area”, in which clinicians could have placed a single “tick” to express concern. Injury to the thoracolumbar junction, lower lumbar spine, multiple internal organs, and pelvis would thus be classified as a single area and unsuspected damage to any of these would not be counted as an unexpected finding. This discrepancy between Shannon et al. and the literature is important, as clinically unexpected findings underpin the reasoning behind performing WBCT and its associated overall reduced mortality.5
References 1. Shannon L, Peachey T, Skipper N, et al. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multitrauma victims. Clin Radiol 2015;70(11):1205e11. 2. Salim A, Sangthong B, Martin M, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006;141(5):468e73.
DOI of original article: http://dx.doi.org/10.1016/j.crad.2015.12.011.
3. Tillou A, Gupta M, Baraff LJ, et al. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma 2009;67(4):779e87. 4. Self ML, Blake AM, Whitley M, et al. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. Am J Surg 2003;186(6):609e13. 5. Caputo ND, Stahmer C, Lim G, et al. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014;77:534e9.
D.F.W. Maclean*, M. Sampson University Hospital Southampton, Southampton, UK * Guarantor and correspondent. E-mail address: [email protected] (D.F.W. Maclean) http://dx.doi.org/10.1016/j.crad.2015.11.022 Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved..
Re: comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. A reply SirdWe are pleased our article has generated some interest and welcome the opportunity to respond to the comments of Maclean and Sampson.1 In our study, we grouped injuries into body areas based on the anatomical regions covered in each part of a wholebody computed tomography (WBCT) examination (head, neck, thorax, abdomen/pelvis). This was to evaluate whether WBCT would pick up unexpected injuries that would be missed on selective scans of specific body regions. Separating the lumbar spine from abdominal viscera or the lungs from the mediastinum does not make practical sense
DOI of original article: http://dx.doi.org/10.1016/j.crad.2015.11.022.