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Emergency Radiology

, Volume 26, Issue 6, pp 655–661 | Cite as

Torso computed tomography in blunt trauma patients with normal vital signs can be avoided using non-invasive tests and close clinical evaluation

  • Elisa Reitano
  • Laura Briani
  • Fabrizio Sammartano
  • Stefania Cimbanassi
  • Margherita Luperto
  • Angelo Vanzulli
  • Osvaldo ChiaraEmail author
Original Article
  • 40 Downloads

Abstract

Purpose

To determine whether torso CT can be avoided in patients who experience high-energy blunt trauma but have normal vital signs.

Methods

High-energy blunt trauma patients with normal vital signs were retrieved retrospectively from our registry. We reviewed 1317 patients (1027 men and 290 women) and 761 (57.8%) fulfilled the inclusion criteria. All patients were initially evaluated at the emergency room (ER), with a set of tests, part of a specific protocol. Patients with at least one altered exam at initial examination or after six-hour observation received a torso CECT. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (NPV), and likelihood ratio (LH) of the protocol were evaluated.

Results

Of 761 patients, 354 (46.5%) received torso CECT because of the positive ER test, with 330 being true positive and 24 being false positive. The remaining 407 patients were negative at ER tests and did not receive torso CECT, showing a significantly (P < 0.001) lower Injury Severity Score (ISS). The positive and negative LH of the protocol to detect torso injuries were respectively 16.5 and 0.01 (overall accuracy of 0.96).

Conclusions

Torso CT can be avoided without adverse clinical outcomes in patients who experience high-energy blunt trauma, are hemodynamically stable, and have normal initial laboratory and imaging tests.

Keywords

High-energy trauma Torso CT scan Emergency department tests Overtriage 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  • Elisa Reitano
    • 1
  • Laura Briani
    • 2
  • Fabrizio Sammartano
    • 1
  • Stefania Cimbanassi
    • 1
  • Margherita Luperto
    • 1
  • Angelo Vanzulli
    • 3
  • Osvaldo Chiara
    • 1
    Email author
  1. 1.General Surgery and Trauma Team, ASST Niguarda MilanoUniversity of MilanoMilanItaly
  2. 2.General Surgery and Trauma Team, ASST Niguarda MilanoUniversity of PaviaMilanItaly
  3. 3.Radiology Department, ASST Niguarda MilanoUniversity of MilanoMilanItaly

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