Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study
Carlos Ordoñez, Ana M Del Valle, Michael Parra, Monica Guzman-Rodriguez, Juan P Herrera-Escobar, Carlos García, Alberto F Garcia, Hernan E Munevar, Constanza Navarro, Alejandra de las Salas, Laura Ibarra, Alfonso Holguin
Citation Information :
Ordoñez C, Del Valle AM, Parra M, Guzman-Rodriguez M, Herrera-Escobar JP, García C, Garcia AF, Munevar HE, Navarro C, de las Salas A, Ibarra L, Holguin A. Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study. Panam J Trauma Crit Care Emerg Surg 2020; 9 (1):26-31.
Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to organ-selective CT (OSCT), and it does not inflict further delays in diagnosis. Materials and methods: We retrospectively review all trauma patients in whom CT scans were performed on arrival at a level I trauma center, from January 2016 to December 2017. Results: A total of 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma, and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma, and head injuries were the most common (71.9%). The OSCT group required subsequent follow-up studies to rule out other injuries, which in turn did not occur in the WBCT group (47.2% vs 0%, p < 0.001). The total radiation exposure dose was higher in the OSCT group [22 mSv (IQR 6–31) vs 15.1 mSv (IQR 9.9–24.8) p < 0.001]. The median CT scan-to-diagnosis time was lower in the WBCT group [22 minutes (14–32) vs 32 minutes (21–65); p < 0.001]. Conclusion: The OSCT has the potential of missing potentially life-threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient\'s overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in diagnosis. Level of evidence: V, therapeutic.
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