Trauma
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Author:
Mikael Häggström [notes 1]
Sudden physical injury:
Contents
Choice of modality
Severe trauma
- Generally whole-body CT according to UK guidelines.[1] Swedish guidelines recommend trauma CTs of the head, neck, chest and abdomen, as well as, if indicated, complementary trauma X-rays.[2]
- 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.[1]
Head
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[3] and UK[4] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[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.[4] 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.[6]
Chest
In blunt chest trauma, US guidelines mainly recommend the following two as complementary examinations:[7]
- X-ray of the chest in trauma
- CT of the chest in trauma, ideally performed as a CT angiography
Abdomen and pelvis
According to US guidelines:[8]
- 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.
Lumbar spine
- 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,[9] 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).[10]
- In children, according to Australian guidelines,[11] but again, low dose CT is arguably superior if there is a local low dose protocol.[10]
- As a follow-up of fractures, since it is almost always enough to check for change in position.[notes 2]
- MRI of the lumbar spine or CT is indicated in children if there are neurological signs.[11]
Extremities
X-ray of fractures is generally the initial choice.
Major targets
By modality
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ NU Hospital Group, Sweden
References
- ↑ 1.0 1.1 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:. 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.
- ↑ 4.0 4.1 . 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
- ↑ 10.0 10.1 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:. ISSN 0284-1851.
- ↑ 11.0 11.1 Australia:. Radiology - Acute indications. The Royal Children's Hospital Melbourne. Retrieved on 2018-12-14.
