Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study

• Main Authors: Maghraby NH, Alshaqaq HM, AlQattan AS, Alfaraj AF, Alghamdi OA, Alzawad MJ, Farcy DA
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-10-01
• Series: Open Access Emergency Medicine
• Subjects: negative rate; whole-body; selective; computed tomography; multiple; polytrauma; mvcs.
• Online Access: https://www.dovepress.com/negative-whole-body-computed-tomography-scans-in-polytrauma-patients-a-peer-reviewed-article-OAEM

Nisreen H Maghraby,1 Hassan M Alshaqaq,2 Abdullah Saleh AlQattan,3 Adnan Fawzi Alfaraj,4 Omar A Alghamdi,2 Malak J Alzawad,5 David A Farcy6 1Department of Emergency Medicine, King Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, AlKhobar, Kingdom of Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 3Department of General Surgery, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia; 4Department of Emergency Medicine, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia; 5Department of Psychiatry, Ministry of Health, Dammam, Kingdom of Saudi Arabia; 6Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida, USACorrespondence: Nisreen H MaghrabyKing Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, 6844 King Faisal University City, Dammam 3026-34211, Saudi ArabiaTel [phone]Email [e-mail]: Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients.Patients and Methods: A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥ 18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients.Results: A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥ 3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation < 94% and GCS ≤ 8 were associated with positive CT scans.Conclusion: Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.Keywords: negative rate, whole-body, selective, computed tomography, multiple, polytrauma, MVCs