Modern CT diagnosis of acute thoracic and abdominal trauma

Abstract

To evaluate a modified algorithm in the diagnostic management of polytraumatized patients by using whole body multislice CT (MSCT) as primary diagnostic tool. Between June 1999 and October 2000 532 polytraumatized patients were referred to the emergency department. 336 polytraumatized patients were primarily evaluated using whole body MSCT according to the "Innsbruck Emergency Algorithm." MSCT is performed immediately after cardiovascular stabilization of the patient. During the initial stabilization period free intraabdominal fluid is excluded or demonstrated by abdominal ultrasound. Time-consuming conventional radiographs are omitted with exception of an optimal chest X-ray. In patients with suspected or obvious arterial injuries or fractures the multislice-CT-dataset is used to perform 2D and 3D reconstructions in order to optimize visualization of additional skeletal and vascular injuries. By means of whole body MSCT it was possible to detect all injuries. The diagnostic advantage of whole body MSCT as compared to conventional X-ray was analyzed in 111 consecutive polytraumatized patients with an injury severity score (ISS) of 34.77. The early use of MSCT shortened the time for diagnostic work-up substantially (approximately 50%). Whole body multislice-CT used as primary diagnostic tool in the management of polytraumatized patients allows for a fast, accurate and comprehensive diagnostic work-up.