Below is an approach used for the "primary survey" of a CT polytrauma/multitrauma (also called trauma CT or whole body CT), often performed at the CT console with the patient still on the CT table. It allows rapid communication of significant findings to the trauma team as well as the decision to perform additional phases (e.g. delayed abdomen scanning).
CT polytrauma typically occurs after the primary survey and in a stable patient 1. There is evidence that polytrauma CT is suitable for unstable patients 2,3, however, policies of scanning these patients will differ based on institutional policy.
The radiologist will typically use a top-to-bottom approach as the brain and cervical spine are usually scanned first without intravenous contrast followed by assessment of the thorax, abdomen and pelvis with the focus on detecting the conditions with the highest mortality in trauma namely: traumatic brain injury and/or intrathoracic/intra-abdominal hemorrhage 4.
CT brain and cervical spine
- brain: bleeding, evidence of increased intracranial pressure, skull fractures
- detection of cervical spine fractures or malalignment suggestive of an unstable injury
CT thorax, abdomen and pelvis
Contrast-enhanced CT is commonly performed in trauma patients, with a large number of different protocols that vary depending on the institution.
- fractures or malalignment suggestive of unstable discoligamentous injury
After the severe injuries that require immediate attention are detected or ruled out, the radiologist will conduct a more thorough search and evaluation of the polytrauma CT.
- 1. Subcommittee, A. T. L. S., Kathryn M. Tchorz, and International ATLS working group. "Advanced trauma life support (ATLS®): the ninth edition." The journal of trauma and acute care surgery 74.5 (2013): 1363.
- 2. Huber-Wagner, Stefan, et al. "Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study." The Lancet 373.9673 (2009): 1455-1461.
- 3. Hilbert, P., et al. "New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm." Injury 38.5 (2007): 552-558.
- 4. Sobrino, Justin, and Shahid Shafi. "Timing and causes of death after injuries." Proceedings (Baylor University. Medical Center) 26.2 (2013): 120.
- 5. Lendemans, S., and S. Ruchholtz. "S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung." Der Unfallchirurg 115.1 (2012): 14-21.
- 6. Krishnam, Mayil S., and John Curtis, eds. Emergency radiology. Cambridge University Press, 2009.
- 7. The Royal College of Radiologists. “Standards of practice and guidance for trauma radiology in severely injured patients, second edition”. London: The royal College of Radiologists,2015
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CT in practice
- iodinated contrast media
- head & neck
- abdomen & pelvis
- CT abdomen/pelvis
- CT abdominal aorta
- CT cholangiography
- CT colonography
- CT enteroclysis
- CT enterography
- CT gastrography
- CT KUB
- CT urogram
- CT IVU
- CT renal 4-phase/3-phase
- CT renal (lesion characterization)
- CT renal split bolus
- CTA mesenteric vessels
- CT pancreas
- CT liver
- three phase
- CT cervical spine
- CT thoracolumbar spine
- CT whole spine
- CT shoulder
- CT pelvis
- CT hip
- CT knee
- CT ankle
- CT foot