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Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The initial assessment of severely injured patients in the resuscitation room requires a systematic and quickly performed survey. Whereas the Advanced Trauma Life Support (ATLS®)-based algorithm recommends focused assessment with sonography in trauma (FAST) among others, recent studies report a survival advantage of early whole-body computed tomography (WBCT) in haemodynamically stable as well as unstable patients. This study assessed the opinions of trauma surgeons about the early use of WBCT in severely injured patients with abdominal trauma, and abdominal CT in patients with isolated abdominal trauma, during resuscitation room treatment.

Methods

An online cross-sectional survey was performed over 8 months. Members of the Swiss Society for Surgery and the Austrian and German associations for trauma surgery were invited to answer nine online questions.

Results

Overall, 175 trauma surgeons from 155 departments participated. For haemodynamically stable patients, most considered FAST (77.6%) and early CT (82.3%) to be the ideal diagnostic tools. For haemodynamically unstable patients, 93.4% considered FAST to be mandatory. For CT imaging in unstable patients, 47.5% agreed with the use of CT, whereas 52.5% rated early CT as not essential. For unstable patients with pathological FAST and clinical signs, 86.8% agreed to proceed with immediate laparotomy.

Conclusions

Most surgeons rely on early CT for haemodynamically stable patients with abdominal trauma, whereas FAST is performed with similar frequency and is prioritized in unstable patients. It seems that the results of recent studies supporting early WBCT have not yet found broad acceptance in the surgical community.

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References

  1. Radvinsky DS, Yoon RS, Schmitt PJ, Prestigiacomo CJ, Swan KG, Liporace FA. Evolution and development of the advanced trauma life support (ATLS) protocol: a historical perspective. Orthopedics. 2012;35(4):305–11.

    Article  PubMed  Google Scholar 

  2. Huber-Wagner S, Biberthaler P, Haberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-body CT in haemodynamically unstable severely injured patients–a retrospective, multicentre study. PLoS One. 2013;8(7):e68880.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373(9673):1455–61.

    Article  PubMed  Google Scholar 

  4. Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129–34.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma. 2010;69(1):84–7.

    Article  PubMed  Google Scholar 

  6. Sierink JC, Treskes K, Edwards MJ, Beuker BJ, den Hartog D, Hohmann J, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet. 2016;388(10045):673–83.

    Article  PubMed  Google Scholar 

  7. Gordic S, Alkadhi H, Hodel S, Simmen HP, Brueesch M, Frauenfelder T, et al. Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol. 1047;2015(88):20140616.

    Google Scholar 

  8. Sierink JC, Saltzherr TP, Wirtz MR, Streekstra GJ, Beenen LF, Goslings JC. Radiation exposure before and after the introduction of a dedicated total-body CT protocol in multitrauma patients. Emerg Radiol. 2013;20(6):507–12.

    Article  CAS  PubMed  Google Scholar 

  9. Laack TA, Thompson KM, Kofler JM, Bellolio MF, Sawyer MD, Laack NN. Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients. J Trauma. 2011;70(6):1362–5.

    Article  PubMed  Google Scholar 

  10. Higashigaito K, Becker AS, Sprengel K, Simmen HP, Wanner G, Alkadhi H. Automatic radiation dose monitoring for CT of trauma patients with different protocols: feasibility and accuracy. Clin Radiol. 2016;71:905–11.

    Article  CAS  PubMed  Google Scholar 

  11. Kahn J, Grupp U, Kaul D, Boning G, Lindner T, Streitparth F. Computed tomography in trauma patients using iterative reconstruction: reducing radiation exposure without loss of image quality. Acta Radiol. 2016;57(3):362–9.

    Article  PubMed  Google Scholar 

  12. TraumaRegister DGU. Deutsche Gesellschaft für Unfallchirurgie (DGU) Jahresbericht 2016. http://www.traumanetzwerkdgu.de/fileadmin/user_upload/alle_webseiten/docs/2016_Jahresbericht_TraumaRegister_DGU_2015.pdf. Accessed 10 Oct 2016.

  13. TraumaRegister DGU. Deutsche Gesellschaft für Unfallchirurgie Jahresbericht 2015. http://www.traumaregister-dgu.de/fileadmin/user_upload/traumaregister-dgu.de/docs/Downloads/TR-DGUJahresbericht_2015.pdf. Accessed 10 Oct 2016.

  14. Kanz KG, Körner M, Linsenmaier U, Kay MV, Huber-Wagner SM, Kreimeier U, et al. Use of multi detector computed tomography for primary trauma survey. Der Unfallchirurg. 2004;107:937–44.

    Article  PubMed  Google Scholar 

  15. Ptak T, Rhea JT, Novelline RA. Experience with a continuous, single-pass whole-body multidetector CT protocol for trauma: three-minute multiple trauma CT scan. Emerg Radiol. 2001;8:250–6.

    Article  Google Scholar 

  16. Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52(3):420–5.

    PubMed  Google Scholar 

  17. Barbosa RR, Rowell SE, Fox EE, Holcomb JB, Bulger EM, Phelan HA, et al. Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S48–52.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Albrecht T, von Schlippenbach J, Stahel PF, Ertel W, Wolf KJ. The role of whole body spiral CT in the primary work-up of polytrauma patients–comparison with conventional radiography and abdominal sonography. Rofo. 2004;176(8):1142–50.

    Article  CAS  PubMed  Google Scholar 

  19. Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology. 1999;212(2):423–30.

    Article  CAS  PubMed  Google Scholar 

  20. Brenchley J, Walker A, Sloan JP, Hassan TB, Venables H. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J. 2006;23(6):446–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Dammers D, El Moumni M, Hoogland II, Veeger N, Ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2017;25(1):1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Carter JW, Falco MH, Chopko MS, Flynn WJ Jr, Wiles Iii CE, Guo WA. Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury. 2015;46(5):817–21.

    Article  PubMed  Google Scholar 

  23. Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery. 2010;148(4):695–700 (discussion -1).

    Article  PubMed  Google Scholar 

  24. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma. 2003;54(1):52–9 (discussion 9–60).

    Article  PubMed  Google Scholar 

  25. Stengel D, Ottersbach C, Matthes G, Weigeldt M, Grundei S, Rademacher G, et al. Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma. CMAJ. 2012;184(8):869–76.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fakhry SM, Watts DD, Luchette FA, East Multi-Institutional Hollow Viscus Injury Research Group. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003;54(2):295–306.

    Article  PubMed  Google Scholar 

  27. Shih T-H, Fan X. Comparing response rates from web and mail surveys: a meta-analysis. Field Methods. 2008;20(3):249–71.

    Article  Google Scholar 

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Acknowledgements

We are thankful to all surgeons that participated in the online survey.

Author information

Authors and Affiliations

  1. Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    L. Grünherz, K. O. Jensen, V. Neuhaus, L. Mica, C. M. L. Werner, B. Ciritsis, G. Osterhoff, H.-P. Simmen & K. Sprengel

  2. Division of Thoracic Surgery, Department of Surgery, Cantonal Hospital Grisons, Loestrasse 170, 7000, Chur, Switzerland

    C. Michelitsch

Authors
  1. L. Grünherz
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  2. K. O. Jensen
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  3. V. Neuhaus
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  5. C. M. L. Werner
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  6. B. Ciritsis
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  7. C. Michelitsch
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  8. G. Osterhoff
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  9. H.-P. Simmen
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  10. K. Sprengel
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Corresponding author

Correspondence to K. Sprengel.

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Conflict of interest

Lisanne Grünherz, Kai Oliver Jensen, Valentin Neuhaus, Ladislav Mica, Clément Werner, Bernhard Ciritsis, Christian Michelitsch, Georg Osterhoff, Hans-Peter Simmen and Kai Sprengel declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Grünherz, L., Jensen, K.O., Neuhaus, V. et al. Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions?. Eur J Trauma Emerg Surg 44, 3–8 (2018). https://doi.org/10.1007/s00068-017-0816-4

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  • DOI: https://doi.org/10.1007/s00068-017-0816-4

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