Abstract
Aim: To determine the utility of tertiary survey (TS) in patients subjected to whole-body CT (WBCT) or selective CT (SCT) following trauma.Methods: A retrospective analysis was performed on trauma patients admitted to a level 2 trauma centre following the introduction of a standardised TS form in 2017. The initial imaging protocol (WBCT versus selective CT versus x-ray), subsequently requested imaging, standardised injury data, and length of stay (LOS) were recorded. Clinically significant injuries were defined as those with an Injury Severity Score (ISS) of 1 on the Abbreviated Injury Scale (AIS).Results: Five hundred and seven patients were included. The rate of additional significant injuries at the time of TS was 1.18% (n=6), each requiring conservative management only. There was no significant difference in injury detection based on the initial imaging protocol; however, there were three near-misses identified. Of these patients, two underwent selective CT and one was subjected to a plain film series, with clinically significant injuries identified early upon completion of trauma imaging. Overall, 2.9% (n=15) of patients had completed trauma imaging during the same admission. WBCT was associated with higher ISS and length of stay (p<0.05). After controlling for ISS, there was no difference in length of stay between imaging modalities except in those patients with an ISS of 0 (no clinically significant injuries), who appeared to have longer admissions if subject to WBCT (p<0.001).Conclusion: The rate of missed injuries identified at TS is low. The imaging modality did not alter this. This may allow for the omission of the tertiary survey and earlier discharge in many trauma patients.
Highlights
University Hospital Geelong (UHG) in Victoria, Australia, is a level 2 trauma centre servicing a large regional population of approximately 500,000 people
We evaluated the effects of early imaging on length of stay (LOS) and the need for completion trauma imaging to further quantify patient radiation risk
A detailed analysis was performed on 507 trauma patients at UHG. 38% (n= 192) of these traumas were female
Summary
University Hospital Geelong (UHG) in Victoria, Australia, is a level 2 trauma centre servicing a large regional population of approximately 500,000 people. UHG sees approximately 13,000 traumas in the emergency department per year, with 25% of these admitted to hospitals [1,2]. The use of eFAST ultrasound and diagnostic adjuncts such as X-ray and CT scanning means that the majority of patients are subject to some form of imaging in the trauma setting. Proponents argue for a decrease in time-consuming and risky transfers, decreased time in the emergency department, and a good injury detection rate [3]. In SCT, clinical assessment combined with point-of-care ultrasound and trauma bay X-ray is employed to direct CT imaging to only the regions of interest, reducing radiation [4]
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