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Fathi M, Mirjafari A, Yaghoobpoor S, Ghanikolahloo M, Sadeghi Z, Bahrami A, Myers L, Gholamrezanezhad A. Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study. Emerg Radiol 2024; 31:251-268. [PMID: 38396199 PMCID: PMC10995012 DOI: 10.1007/s10140-024-02213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Trauma is a significant cause of mortality and morbidity. It is crucial to diagnose trauma patients quickly to provide effective treatment interventions in such conditions. Whole-body computed tomography (WBCT)/pan-scan is an imaging technique that enables a faster and more efficient diagnosis for polytrauma patients. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of WBCT in diagnosing injuries in polytrauma patients. We will also assess its impact on the mortality rate and length of hospital stay among trauma centers between patients who underwent WBCT and those who did not (non-WBCT). Twenty-seven studies meeting our inclusion criteria were selected among PubMed, Scopus, Web of Science, and Google Scholar. The criteria were centered on the significance of WBCT/pan-scan application in trauma patients. Stata version 15 was used to perform statistical analysis on the data. The authors have also used I2 statistics to evaluate heterogeneity. Egger and Begg's tests were performed to rule out any publication bias. Total of twenty-seven studies including 68,838 trauma patients with a mean age of 45.0 ± 24.7 years were selected. Motor vehicle collisions were the most common cause of blunt injuries (80.0%). Head, neck, and face injuries were diagnosed in 44% (95% CI, 0.28-0.60; I2 = 99.8%), 6% (95% CI, 0.02-0.09; I2 = 97.2%), and 9% (95% CI, 0.05-0.13; I2 = 97.1%), respectively. Chest injuries were diagnosed by WBCT in 39% (95% CI, 0.28-0.51; I2 = 99.8%), abdominal injuries in 23% (95% CI, 0.03-0.43; I2 = 99.9%) of cases, spinal injuries 19% (95% CI, 0.11-0.27; I2 = 99.4%), extremity injuries 33% (95% CI, 0.23-0.43; I2 = 99.2%), and pelvic injuries 11% (95% CI, 0.04-0.18; I2 = 97.4%). A mortality odd ratio of 0.94 (95% CI, 0.83-1.06; I2 = 40.1%) was calculated while comparing WBCT and non-WBCT groups. This systematic review and meta-analysis provide insight into the possible safety, efficacy, and efficiency of WBCT/pan-scan as a diagnostic tool for trauma patients with serious injuries, regardless of their hemodynamic status. In patients with serious injuries from trauma, whether or not there are indicators of hemodynamic instability, our recommended approach is to, wherever possible, perform a WBCT without stopping the hemostatic resuscitation. By using this technology, the optimal surgical strategy for these patients can be decided upon without causing any delays in their final care or greatly raising their radiation dose.
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Affiliation(s)
- Mobina Fathi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshia Mirjafari
- Center for Minimally Invasive Therapeutics (C-MIT), University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, USA
| | - Shirin Yaghoobpoor
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zohre Sadeghi
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Ashkan Bahrami
- Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran
| | - Lee Myers
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, USA.
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Wirth S, Hebebrand J, Basilico R, Berger FH, Blanco A, Calli C, Dumba M, Linsenmaier U, Mück F, Nieboer KH, Scaglione M, Weber MA, Dick E. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 2020; 11:135. [PMID: 33301105 PMCID: PMC7726597 DOI: 10.1186/s13244-020-00947-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. RESULTS Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article). CONCLUSIONS Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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Affiliation(s)
- Stefan Wirth
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria.
- Department of Radiology, LMU University Hospital, Munich, Germany.
- Department of Radiology and Nuclear Medicine, Schwarzwald-Baar-Hospital, Villingen-Schwenningen, Germany.
| | - Julian Hebebrand
- Department of Radiology, LMU University Hospital, Munich, Germany
| | - Raffaella Basilico
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Neurosciences, Imaging and Clinical Science, University of Chieti, Chieti, Italy
| | - Ferco H Berger
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ana Blanco
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Hospital JM Morales Meseguer, Murcia, Spain
| | - Cem Calli
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Maureen Dumba
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
| | - Ulrich Linsenmaier
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Fabian Mück
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Konraad H Nieboer
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Ziekenhuis, Vrije University (VUB), Brussels, Belgium
| | - Mariano Scaglione
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- James Cook University Hospital, Teesside University, Middlesbrough, UK
- Department of Imaging, Pineta Grande Hospital, Castel Volturno, Italy
| | - Marc-André Weber
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Elizabeth Dick
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
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