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Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?

BACKGROUND: Whole-body multislice computed tomography (WB-MSCT) has become an important diagnostic tool in the early treatment phase of severely injured patients. The optimal moment of WB-MSCT’s use during this treatment phase remains unclear. Many trauma centers use WB-MSCT in addition to conventio...

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Autores principales: Topp, Tobias, Lefering, Rolf, Lopez, Caroline L, Ruchholtz, Steffen, Ertel, Wolfgang, Kühne, Christian A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385136/
https://www.ncbi.nlm.nih.gov/pubmed/25852773
http://dx.doi.org/10.1186/s12245-015-0053-8
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author Topp, Tobias
Lefering, Rolf
Lopez, Caroline L
Ruchholtz, Steffen
Ertel, Wolfgang
Kühne, Christian A
author_facet Topp, Tobias
Lefering, Rolf
Lopez, Caroline L
Ruchholtz, Steffen
Ertel, Wolfgang
Kühne, Christian A
author_sort Topp, Tobias
collection PubMed
description BACKGROUND: Whole-body multislice computed tomography (WB-MSCT) has become an important diagnostic tool in the early treatment phase of severely injured patients. The optimal moment of WB-MSCT’s use during this treatment phase remains unclear. Many trauma centers use WB-MSCT in addition to conventional radiographs, while some trauma centers use WB-MSCT as the only radiological tool. The aim of this study was to determine the differences between these two protocols and to answer the question of whether conventional radiographs can still be used in the safe treatment of polytrauma patients. METHODS: Patients from the TraumaRegister DGU® with an injury severity score (ISS) of ≥16 were included. Group I received conventional radiographs and focused assessment with sonography in trauma (FAST) prior to a WB-MSCT, and group II received an initial WB-MSCT and FAST. Both groups were compared concerning treatment time and outcome. RESULTS: A total of 3,995 patients in group I were compared to 4,025 patients in group II. There were no differences in ISS (29.97 vs. 29.94), gender (male: 73.5% vs. 72.8%), age (45.47 vs. 45.12 years), or calculated mortality (21.41% vs. 21.44%). Time needed in the resuscitation room was slightly longer in group I (72 vs. 64 min); the durations until admittance to the ICU and arrival to the OR were not significantly different between the groups. There was no difference in mortality (18.2% vs. 18.4%) or the standardized mortality ratio (SMR) (0.85 vs. 0.86). CONCLUSIONS: WB-MSCT plays an inherent role in the treatment of multiple-injured patients. However, the use of WB-MSCT as the only diagnostic method in the resuscitation room is not needed. Conventional radiographs and FAST followed by WB-MSCT can be performed in the early resuscitation phase without impairing patient outcomes. This approach enables the emergency room team to perform life-saving procedures - chest-tube insertion, laparotomy, cardiopulmonary resuscitation -immediately and simultaneous. Nevertheless, randomized multi-center trials are needed to determine the comparability and effectiveness of these algorithms.
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spelling pubmed-43851362015-04-07 Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer? Topp, Tobias Lefering, Rolf Lopez, Caroline L Ruchholtz, Steffen Ertel, Wolfgang Kühne, Christian A Int J Emerg Med Original Research BACKGROUND: Whole-body multislice computed tomography (WB-MSCT) has become an important diagnostic tool in the early treatment phase of severely injured patients. The optimal moment of WB-MSCT’s use during this treatment phase remains unclear. Many trauma centers use WB-MSCT in addition to conventional radiographs, while some trauma centers use WB-MSCT as the only radiological tool. The aim of this study was to determine the differences between these two protocols and to answer the question of whether conventional radiographs can still be used in the safe treatment of polytrauma patients. METHODS: Patients from the TraumaRegister DGU® with an injury severity score (ISS) of ≥16 were included. Group I received conventional radiographs and focused assessment with sonography in trauma (FAST) prior to a WB-MSCT, and group II received an initial WB-MSCT and FAST. Both groups were compared concerning treatment time and outcome. RESULTS: A total of 3,995 patients in group I were compared to 4,025 patients in group II. There were no differences in ISS (29.97 vs. 29.94), gender (male: 73.5% vs. 72.8%), age (45.47 vs. 45.12 years), or calculated mortality (21.41% vs. 21.44%). Time needed in the resuscitation room was slightly longer in group I (72 vs. 64 min); the durations until admittance to the ICU and arrival to the OR were not significantly different between the groups. There was no difference in mortality (18.2% vs. 18.4%) or the standardized mortality ratio (SMR) (0.85 vs. 0.86). CONCLUSIONS: WB-MSCT plays an inherent role in the treatment of multiple-injured patients. However, the use of WB-MSCT as the only diagnostic method in the resuscitation room is not needed. Conventional radiographs and FAST followed by WB-MSCT can be performed in the early resuscitation phase without impairing patient outcomes. This approach enables the emergency room team to perform life-saving procedures - chest-tube insertion, laparotomy, cardiopulmonary resuscitation -immediately and simultaneous. Nevertheless, randomized multi-center trials are needed to determine the comparability and effectiveness of these algorithms. Springer Berlin Heidelberg 2015-02-28 /pmc/articles/PMC4385136/ /pubmed/25852773 http://dx.doi.org/10.1186/s12245-015-0053-8 Text en © Topp et al.; licensee Springer. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Original Research
Topp, Tobias
Lefering, Rolf
Lopez, Caroline L
Ruchholtz, Steffen
Ertel, Wolfgang
Kühne, Christian A
Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title_full Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title_fullStr Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title_full_unstemmed Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title_short Radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
title_sort radiologic diagnostic procedures in severely injured patients - is only whole-body multislice computed tomography the answer?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385136/
https://www.ncbi.nlm.nih.gov/pubmed/25852773
http://dx.doi.org/10.1186/s12245-015-0053-8
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