Necessity for a Whole-body CT Scan in Alert Blunt Multiple Trauma Patients

Mun,  You Ho; Kim,  Yun Jeong; Shin,  Soo Jeong; Park,  Dong Chan; Park,  Sin Ryul; Ryu,  Hyun Wook; Seo,  Kang Suk; Park,  Jung Bae; Chung,  Jae Myung; Bae,  Ji Hye

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Original Article

Journal of the Korean Society of Traumatology 2010;23(2):89-95.

Necessity for a Whole-body CT Scan in Alert Blunt Multiple Trauma Patients

You Ho Mun, Yun Jeong Kim, Soo Jeong Shin, Dong Chan Park, Sin Ryul Park, Hyun Wook Ryu, Kang Suk Seo, Jung Bae Park, Jae Myung Chung, Ji Hye Bae

¹Department of Emergency Medicine, College of Medicine, Kyungpook National University, Daegu, Korea. eumto@hanmail.net
²Department of Radiology, College of Medicine, Kyungpook National University, Daegu, Korea.

의식이 명료한 다발성 외상환자에게
전신 전산화단층촬영이 반드시 필요한가?

문유호∙김윤정∙신수정∙박동찬∙박신율∙류현욱∙서강석∙박정배∙정제명∙배지혜¹

경북대학교 의과대학 응급의학교실, 영상의학교실¹

Abstract

PURPOSE
Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable.
METHODS
This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings.
RESULTS
One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6+/-18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0+/-10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery.
CONCLUSION
Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

Key Words: Multiple trauma; Computed tomography; Radiation injuries

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