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)
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 and pelvis 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.
- As a follow-up of fractures, since it is almost always enough to check for change in position.[notes 2]
X-ray of fractures is generally the initial choice.
- Artigas Martín, J.M.; Martí de Gracia, M.; Claraco Vega, L.M.; Parrilla Herranz, P. (2015). "Radiology and imaging techniques in severe trauma ". Medicina Intensiva (English Edition) 39 (1): 49–59. doi:10.1016/j.medine.2014.06.003. ISSN 21735727.
- 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
- USA:. ACR Appropriateness Criteria. American College of Radiology. Last review date: 2012
- 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.