Sudden physical injury:
Choice of modality
- Generally whole-body CT according to UK guidelines. Swedish guidelines recommend trauma CTs of the head, neck, chest and abdomen, as well as, if indicated, complementary trauma X-rays.
- If CT is not readily available, X-ray in trauma (including at least X-ray of the thorax and X-ray of the abdomen and pelvis) and FAST scan.
CT of the head in trauma, without IV contrast, is the first choice of investigation.
Neck (cervical spine)
In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, but when indicated, recommendations differ somewhat between children and adults:
- In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US and UK guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5. It is thus reasonable to indicate CT by a combination of higher severity and older age.
- In adults, UK guidelines are largely similar as in children. US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.
In blunt chest trauma, US guidelines mainly recommend the following two as complementary examinations:
Abdomen and pelvis
According to US guidelines:
- The initial choice is generally CT of the abdomen in trauma if the patient is stable enough for the exam.
- In unstable patients, X-ray of the thorax, X-ray of the abdomen and pelvis and FAST scan are preferable if they can be done with relatively little interference with resuscitation.
- CT of the lumbar spine in trauma is generally the first choice.
- X-ray of fractures of the lumbar spine is recommended as the first choice in:
- Suspicion of a vertebral compression fracture alone, such as in an elderly patient with typical symptoms.
- Low clinical suspicion of a fracture, according to US guidelines, but low dose CT is still arguably superior if the local department has a low dose protocol (with up to only slightly larger radiation dose than X-ray).
- In children, according to Australian guidelines, but again, low dose CT is arguably superior if there is a local low dose protocol.
X-ray of fractures is generally the initial choice.
- For a full list of contributors, see article Radlines:Authorship for details. . Creators of images are attributed at the image description pages, seen by clicking on the images. See
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- Helén Milde, John Brandberg (2018-12-19). DTs Multitrauma rutiner. Sahlgrenska University Hospital, Gothenburg.
- Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
- . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
- . Traumamanual. Region Skåne. Last updated: 2018-03-29
- Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
- . Blunt Chest Trauma, ACR Appropriateness Criteria. American College of Radiology. Date of origin: 2013
- . Blunt Abdominal Trauma, ACR Appropriateness Criteria. American College of Radiology. Last review date: 2012
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- Alshamari, Muhammed; Geijer, Mats; Norrman, Eva; Lidén, Mats; Krauss, Wolfgang; Wilamowski, Franciszek; Geijer, Håkan (2015). "Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice ". Acta Radiologica 57 (5): 602–611. doi:10.1177/0284185115595667. ISSN 0284-1851.
- Australia:. Radiology - Acute indications. The Royal Children's Hospital Melbourne. Retrieved on 2018-12-14.