An evidence based blunt trauma protocol

• Published in: Emergency medicine journal : EMJ Vol. 30; no. 3; p. e23
• Main Authors: van Vugt, Raoul, Kool, Digna R, Lubeek, Satish F K, Dekker, Helena M, Brink, Monique, Deunk, Jaap, Edwards, Michael J R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.03.2013; BMJ Publishing Group LTD
• Subjects: Abdomen; Adolescent; Adult; Clinical Protocols; CT/MRI; Emergency services; Evidence-Based Medicine; Female; Glasgow Coma Scale; Humans; imaging; Injury Severity Score; Length of Stay - statistics & numerical data; Male; Medical imaging; Middle Aged; Patient safety; Pilot Projects; Prospective Studies; protocol; resuscitation; Risk Factors; Tomography; Tomography, X-Ray Computed - utilization; trauma; Ultrasonography; Vital Signs; wounds and injuries; Wounds, Nonpenetrating - diagnostic imaging; x-ray computed
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emermed-2011-200802

Objective Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this study's aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt high-energy trauma patients, especially for the use of CT. Methods An evidence-based flow chart was created with criteria based on trauma mechanism, physical examination and laboratory analyses to indicate appropriateness of conventional radiography (CR), sonography and CT of head, cervical spine and trunk. To evaluate this protocol, the authors prospectively included 81 consecutive patients. Collected data included protocol adherence and number and type of performed CR and CT scans. The authors also determined the time needed to perform radiological investigations, adverse events in the CT room and clinically relevant missed injuries after 1-month clinical follow-up. Results There was 99% adherence to the protocol concerning CT. Seventy-nine patients (98%) received one or more CT scans: 72 (89%) had thoracoabdominal, 78 (96%) cervical spine and 54 (67%) had cranial CT. In 30 patients, one or more CT scans of body regions could be omitted. In 38%, CR was wrongly omitted or performed incorrectly at a variance with the protocol. No major adverse events occurred in the CT room and no clinically relevant injuries were missed. Conclusions The authors introduced a diagnostic protocol that seems feasible and safe for the evaluation of adult blunt high-energy trauma patients. Implementation of this protocol has the potential to reduce unnecessary radiological investigations, especially CT scans.