Re: comparison of clinically suspected injuries detected at whole-body CT in suspected multi-trauma victims

Abstract

Sir—Shannon et al.1 Shannon L. Peachey T. Skipper N. et al. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. Clin Radiol. 2015; 70: 1205-1211 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar found that 32% of trauma whole-body 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 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: 468-473 Crossref PubMed Scopus (281) Google Scholar was quoted by Shannon et al., describe “clinically unexpected finding” rates of between 17% and 38%, 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: 468-473 Crossref PubMed Scopus (281) Google Scholar , 3 Tillou A. Gupta M. Baraff L.J. et al. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 2009; 67: 779-787 Crossref PubMed Scopus (98) Google Scholar , 4 Self M.L. Blake A.M. 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: 609-613 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar 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 Caputo N.D. 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: 534-539 Crossref PubMed Scopus (100) Google Scholar Re: comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. A replyClinical RadiologyVol. 71Issue 4PreviewSir—We are pleased our article has generated some interest and welcome the opportunity to respond to the comments of Maclean and Sampson.1 Full-Text PDF