Abstract
Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It takes significant clinical expertise to detect multiple injuries and implement life or limb saving treatment within a short period of time. Conventional radiographs and focused assessment with sonography for trauma (FAST) scans are useful adjuncts to help in initial diagnosis. Conventional computer tomography (CT) investigations have been used for secondary survey in these scenarios. We reviewed the guidelines that regulate the use of CT scans in multiple injured patients in the UK. CT imaging is rapidly emerging as an adjunct to primary survey. It allows quick detection of major organ injury allowing focussed treatment whilst simultaneous initial resuscitation is underway. Availability of adequate resources is needed for widespread adaptation of this technique that involves manpower, relocation and refurbishment of the CT suites. Although it is not yet clear if using CT imaging during primary survey reduces mortality, it surely results in more organised patient care and efficient use of resources in an acute setting.
Highlights
Management of patients with multiple injuries is challenging
We reviewed the guidelines outlined by advanced trauma life support (ATLS), Royal College of Radiologists (RCR) and British Orthopaedic Association (BOA) on undertaking computer tomography (CT) scans in management of multiple injured patients nationally
Immediate CT scan can be a useful adjunct to primary survey in polytrauma patients
Summary
Management of patients with multiple injuries is challenging. With improvement in pre hospital care and advancement in early diagnosis of life threatening injuries, the mortality in polytrauma patients have substantially decreased in last thirty years [1]. Measures must be taken before transferring the patients to CT suite to enhance quick and safe imaging These include an intravenous access to ensure contrast injection, a pelvic stabilisation in case of suspected pelvic fracture, adequate splinting of deformed limbs, urinary catheterisation and pregnancy test to exclude untoward radiation of pregnant women. In haemodynamically unstable patients CT scan with contrast should be used as an adjunct to primary survey and aimed at detecting acute life-threatening injuries This should be used where there is clinical evidence of bleeding or a high likelihood of vascular trauma. The British Orthopaedic Association guidelines (BOAST 3) for acetabular and pelvic fracture management outline the need for CT scans for defining pelvic injury They do recommend early CT scan if available in the emergency department unless it interferes with the initial resuscitation of the patient. Magnetic resonance imaging (MRI) is urgent in cases of spinal cord compression
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