The diagnostic efficacy of low-dose cervical and thoracic CT in multiple trauma patients

Abstract

Objective: The aim of this study was to evaluate the initial diagnostic efficacy of low-dose computed tomography (CT) in multi-trauma patients. Methods: 74 patients (44 male, 30 female; average age: 36.9 years) accepted to the emergency unit with the reason of multiple trauma which is included in this study. Cervical and thoracic injury sites were initially evaluated with portable X-Ray and low-dose CT. The Patients\' progress, surgical findings and additional radiologic examination results were recorded until the patients were discharged. Results: The sensitivity and specificity of X-Ray graphies were 50% and 95% for thoracic traumatic pathologies; 0-40% and 95-100% for cervical injuries respectively. CT examination sensitivity and specificity values were 95-100% and 80-100% for thoracic injuries; 95-100% and 96-100% for cervical injuries respectively. Conclusion: Low-dose CT examination is more sensitive than X-Ray graphs for the evaluation of cervicothoracic traumatic injuries. We recommend to prefer low-dose CT as an initial radiologic examination for managing cervicothoracic trauma cases because of its higher diagnostic capability than X-Ray graphy.

Keywords

• Low-dose CT, X-Ray, multiple traumas

Multipl travmada servikal ve torakal düşük doz spiral BT\'nin tanısal etkinliği

Abstract

Amaç: Amacımız çoklu travma hastalarının tanısında, düşük doz bilgisayarlı tomografinin (BT) değerini araştırmaktı. Yöntemler: Acil servise çoklu travma nedeniyle başvuran 74 hasta (30 kadın, 44 erkek) çalışmaya dahil edildi. Direkt röntgen ve düşük doz BT ile servikal bölge ve toraks bölge yaralanmaları değerlendirildi. Hastalar hastaneden taburcu edilene kadar, gidişatları, cerrahi bulguları, ek olarak radyolojik bulguları kaydedildi. Bulgular: Radyografinin duyarlılığı ve özgüllüğü sırasıyla torakal patolojilerde, %50, %95; servikal travmalarda ise %0-40 ve %95-100 idi. BT\'nin duyarlılığı ve özgüllüğü sırasıyla %95-100 ve %80-100; torakal travmalarda %95-100 ve %96-100 olarak bulundu. Sonuç: Servikotorakal travmaların değerlendirilmesinde düşük doz BT, daha duyarlıdır. Düşük doz BT ile hasta takibinin de değiştiği saptandı. Servikotorasik bölge travmalarının değerlendirilmesi ve takibinde, başlangıç olarak düşük doz BT, radyografik yönteme tercih edilebilir.

Keywords

• Düşük doz BT, röntgen, çoklu travmalar

References

1. Ruiz E. Initial Approach to the trauma patient In: Tintinalli JE, Ruiz E, Krome RL, eds. Emergency Medicine: A Com- prehensive Study Guide. 4th ed. New York, NY: McGraw Hill; 1127-1131:1996.
2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Sta- tistics Query and Reporting System (WISQARS) [online] (2007) [cited 2011 Mar 4]. Available from URL: http:// www.cdc.gov/injury/wisqars.
3. Harris JH Jr. What is the minimum number of plain ra- diographs necessary to evaluate the cervical spine in pa- tients who have had trauma? Questions and answers. AJR 1994;163:217-218.
4. West OC, Anbari MM, Pilgram TK, Wilson AJ. Acute cer- vical spine trauma: Diagnostic performance of single- view versus three-view radiographic screening. Radiology 1997;204:819-823.
5. Alexander RH, Proctor HJ. Advanced Trauma Life Support (ATLS™) Course for Physicians. Chicago, Ill: American College of Surgeons, 1993.
6. Velmahos GC, Theodorou D, Tatevossian R, et al. Radio- graphic cervical evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing? J Trauma 1996;40:768-774.
7. Pech P, Kilgore DP, Pojunas KW, Haughton VM. Cervical spine fractures: CT detection. Radiology 1985;157:117- 120.
8. Blacksin MF, Lee HJ. Frequency and significance of frac- tures of the upper cervical spine detected by CT in patients with severe neck trauma. AJR 1995; 165:1201-1204.

9. Berne JD, Velmahos GC, El-Tawil Qalid, et al. Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. The Journal of Trauma: Injury, Infection and Critical Care 1999; 47:896-903.
10. Gavant ML, Menke PG, Fabian T, et al. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radi- ology 1995;197:125-133.
11. Worthy SA, Kang EY, Hartman TE, et al. Diaphragmatic rupture: CT findings in 11 patients. Radiology 1995; 194:885-88.
12. Unger JM, Schuchmann GG, Grossman JE, Pellett JR. Tears of the trachea and bronchi caused by blunt trauma: radiologic findings. AJR 1989;153:1175-1180.
13. Wagner RB, Crawford WO, Schimpf PP. Classifica- tion of the parenchymal injuries of the lung. Radiology 1988;167:77-82.
14. Kuhlman JE, Pozniak MA, Collins J, Knisely BL. Ra- diographic and CT findings of blunt chest trauma: aor- tic injuries and looking beyond them. Radiographics 1998;18:1085-1106.
15. Shuman WP. CT of blunt abdominal trauma in adults. Radi- ology 1997;205:297-306.
16. Becker CD, Gal I, Baer HU, Vock P. Blunt hepatic trauma in adults: correlation of CT injury. Grading with outcome. Radiology 1996;201:215-220.
17. Benya EC, Bulas DI, Eichelberger MR, Sivit CJ. Splenic injury from blunt abdominal trauma in children: follow-up evaluation with CT. Radiology 1995;195:685-688.
18. Novelline RA, Rhea JT, Bell Timothy. Helical CT of ab- dominal trauma. Radiol Clin North Am 1999;37:591-612.
19. Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201:798-802.
20. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105.
21. Le Blang SD, MD, Nunez DB. Radiol Clin North Am 1999;37:515-532.
22. Fritz M. et al: Imagıng of chest trauma: radiological pat- terns of injury and diagnostic algorithms. Eur J Radiol 2003;48:61-70.
23. H. Imhof, M Fuchsjager. Traumatic injuries: Imaging of spi- nal injuries: Eur Radiol 2002;12:1262-1272.
24. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma pa- tients. JAMA 2001;286:1841-1848.
25. Frankel HL, Rozycki GS, Ochsner MG, et al. Indications of obtaining surveillance thoracic and lumbar spine radio- graphs. J Trauma 1994;37:673-676.
26. Widder S, Doig C, Burrowes P, et al. Prospective evaluation of computed tomographic scanning for spinal clearance of obtunded trauma patients: preliminary results. J Trauma 2004;56:1179-1184.
27. Blackmore CC, Ramsey SD, Mann FA, et al. Cervical spine screening with CT in trauma patients: a cost effectiveness analysis. Radiology 1999;212:117-125.
28. Brandt MM, Wahl WL, Yeom K, et al. Computed tomo- graphic scanning reduces costs and time of complete spine evaluation. J Trauma 2004;56:1022-1028.
29. Tins BJ, Cessar-Pullicino VN. Imaging of acute cer- vical spine injuries: review and outlook. Clin Radiol 2004;59:865-880.
30. Blackmore CC, Mann FA, Wilson AJ. Helical CT in the pri- mary trauma evaluation of the cervical spine: an evidence based approach. Skeletal Radiol 2000;29:632-639.
31. Sundgren PC, Philipp M, Pavel VP, Maly P. Spinal Trauma. Neuroimag Clin N Am 2007;17: 73-85.
32. Diaz JJ Jr, Gillman C, Morris JA Jr, et al. Are five view plain films of the cervical spine unreliable? A prospective evalu- ation in blunt trauma in patients with altered mental status. J Trauma 2003;55:658-663.
33. Griffen MM, Frykberg ER, Kerwin AJ, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan? J Trauma 2003;55:222-226.
34. Holmes JF, Mirvis SE, Panacek EA, et al. For theNEXUS Group. Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries. J Trauma 2002;53:524-529.
35. Kligman M, Vasili C, Roffman M. The role ofcomputed to- mography in cervical spine injury due to diving. Arch Or- thop Trauma Surg 2001;121:139-1341.
36. Schenarts PJ, Diaz J, Kaiser C, et al. Prospective compari- son of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma 2001;51:663-668.
37. Berne JD, Velmahos GC, El Tawil Q, et al. Value of com- plete cervical helical computed tomographic scanning in identifying cervical spine injury in the unavailable blunt trauma patient with multiple injuries: a prospective study. J Trauma 1999;47:896-902.
38. Luis A. Rivas, et al: Multislice CT in thorasic trauma:Radiol Clin Am 2003;41:599-616.
39. Wicky S, Wintermark M, Schnyder P, et al. Imaging of blunt chest trauma. Eur Radiol 2000;10:1524-1538.
40. Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Seminars inUltrasound, CT & MR 2005;26:305-331.
41. Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Seminars inUltrasound, CT & MR. 2005;26:305-331
42. Sroka NL, Combs J, Mood R, Henderson V. Scout an- teroposterior and lateral CT scans as ascreening test for thoracolumbar spine injury in blunt trauma. Am Surg 2007;73:780-743.
43. Magu S, Yadav A, Agarwal S. Computed Tomography in Blunt Chest Trauma. Indian J Chest Dis Allied Sci 2009;51:75-81.
44. Mirvis S. Diagnostic imaging of acute thoracic injury. Sem- inars in Ultrasound, CT & MR. 2004;25:156-179.
45. Omert L, Yeaney W, Protetch J. Efficacy of thoracic com- puterized tomography in blunt chest trauma. Am Surg 2001;67:660-664.