Whole-Body CT after Motor Vehicle Crash: No Benefit after High-Energy Impact and with Normal Physical Examination

Abstract

Performing a whole body computerized tomography (CT) scan after a motor vehicle crash (MVC) when the physical exam suggests no new injury remains a source of debate. It remains a common practice despite prospective evidence of no reduction in mortality. Prior retrospective studies have shown a potential mortality benefit of whole-body CT following these traumas compared to selective scanning, but the overall quality of evidence is lacking. Proponents argue that whole-body CT finds more injuries and injuries that may have been missed on exam, but it comes with the cost of radiation exposure, possible adverse effects of iodine contrast, and added expense. The Vittel criteria, originally used for field triage, now guide whole-body CT decisions in France. The Vittel criteria include physiologic variables, kinetic components or mechanism of injury, injuries sustained, and resuscitation required. Use of these criteria as an indication to perform whole-body CT has lacked specificity. Investigators in this retrospective study hypothesized that patients involved in an MVC with a GCS of 15, a normal exam of the torso, and only a kinetic component of the Vittel criteria, whole-body CT is not indicated.