Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Původní práce / Original papers

ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL.,
86, 2019, p. 334 - 341

Celotělové CT a další zobrazovací metody při vyšetření pacienta s  polytraumatem - výsledky dotazníkové studie mezi traumacentry v České republice

Whole-Body CT Scan and Other Imaging Techniques in Examining Polytrauma Patients - Outcomes of a Questionnaire Survey of Trauma Centres in the Czech Republic

D. GIRSA1,3, J. WEICHET1, H. MALÍKOVÁ1,2
1 Radiodiagnostická klinika, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady v Praze
2 Ústav anatomie, 2. lékařská fakulta Univerzity Karlovy, Praha
3 Postgraduální studium, 2. lékařská fakulta Univerzity Karlovy, Praha

ABSTRACT

PURPOSE OF THE STUDY

The study aimed to map the use of imaging techniques and results reporting in polytrauma patients by the trauma centres in the Czech Republic.

MATERIAL AND METHODS

The representatives of radiology departments and units of all 12 trauma centres in the Czech Republic completed a questionnaire regarding the imaging in polytrauma patients.

RESULTS

The Focused Assessment with Sonography for Trauma (FAST) as an initial imaging is used by all the centres, the Whole-Body CT scan (WBCT) is the dominant imaging technique everywhere and all the centres have standards in place for its performance. The WBCT examination protocol varies across the centres, just like the evaluation procedures of the CT scan and reporting of the results over to the indicating physicians. In majority of centres, there is a high percentage of WBCT with normal findings. One of the centres which uses also X-rays as a part of imaging algorithm, reports a notably higher percentage of WBCT positive findings.

DISCUSSION

When considering the radiation dose, data and time necessary for WBCT, work required to assess the WBCT and a large number of negative findings, it is disputable whether in a number of cases the WBCT is a suitable method for polytrauma patient examination. Similar conclusions have been drawn also by other authors who recommend that the WBCT is always used for unconscious polytrauma patients, in whom a clinical examination is virtually impossible. In the other cases, based on the clinical parameters the other imaging techniques and the focused CT (and in the indicated cases also the whole-body CT) can be safely used.

CONCLUSIONS

The diagnostic procedure in a polytrauma patient is not uniform in trauma centres and even the procedure for urgent reporting of crucial WBCT findings to clinical physicians has not been standardised. In a number of cases the indication for WBCT seems to be unnecessary. A more careful consideration of indications for imaging examinations based on the clinical finding may reduce the radiation exposure of patients while maintaining the diagnostic accuracy. A structured report on WBCT in polytrauma is not used even though it is recommended by the European Society of Radiology.

Key words: polytrauma, diagnostic imaging, Whole-Body Computed Tomography, structured report

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