Whole-Body Imaging in Blunt Multisystem Trauma Patients Who Were Never Examined

Autor: Graham E. Snyder
Rok vydání: 2008
Předmět:
Zdroj: Annals of Emergency Medicine. 52:101-103
ISSN: 0196-0644
DOI: 10.1016/j.annemergmed.2007.03.023
Popis: Rarely in one’s career does a physician come across an article that results in a major change in his or her practice pattern. More rare still is an article that affects a specialty as a whole. Last year a practice-changing article was published and is already being indoctrinated into the present and future physicians of the United States. “Whole Body Imaging in Blunt Multisystem Trauma Patients without Obvious Signs of Trauma,” by Salim et al, professes conclusions that, if widely implemented, could make the difference between life and death for thousands of trauma patients a year. The irony is that the patients treated under the article’s guidelines will be the ones with the needless deaths. Since Marie Curie popularized the portable radiograph for trauma and died from radiation exposure a century ago, the medical community has known the dangers of radiation. We wear lead aprons and collars to protect ourselves from the scatter of portable chest radiograph, yet that is less than 1% of the radiation from a whole-body computed tomography (CT) scan. We have an obligation to protect our patients, as well as ourselves. Physicians are both lured and reassured by the convenience of a negative CT scan because it effectively rules out significant injury in most trauma patients. However, when significant injury is not suspected after examination and medical historytaking, the risk of the radiation is unacceptably high. It is inappropriate for a pan-scan with a radiation-induced mortality of 1 in 1,250 to be used as a screening test. In the Salim et al study, the physicians set out to prove that “the use of liberal whole body imaging based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury.” All 1,000 patients in the study had pan-scans, that is, CT of the brain, neck, chest, abdomen, and pelvis after blunt trauma. Sixty percent of the patients studied had pan-scans based on “significant mechanism” alone. Forty percent were clinically unevaluable. Two of the notable “significant mechanisms” were motor vehicle crash at greater than 35 miles per hour and assault with a depressed level of consciousness. (Eleven percent of the patients had a Glasgow Coma Scale score of 3 to 8. It is unclear why these patients who
Databáze: OpenAIRE
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