Optimisation of CT scanning protocols for polytrauma patients

Abstract

Introduction Traumatic injuries are one of the top ten causes of death in all race/sex groups, and the main reason in children and young adults (1-45 years of age). (1) The cut-off values for polytrauma defining parameters, such as Injury Severity Scores (ISS) vary between 16 - 25 and sometimes require additional data (such as two or more injured body regions, high Abbreviated Injury Score (AIS)). (2) The severity and high mortality in polytrauma patients (PP) requires quick, standardized and organized care protocols, hence the implementation of Advanced Trauma Life Support (ATLS) guideline in clinical practice. The first steps of emergency care are clinical evaluation, chest X-ray and Focused Assessment with Sonography in Trauma (FAST). The necessity for organ-specific computed tomography (CT) is determined individually, based on preliminary data.(3,4) CT imaging has become critical in emergency diagnostics to the point where whole body CT (WBCT) scans are being recommended as a main diagnostic tool for PP. (5) However, with the widespread use of CT scans, especially contrast enhanced or WBCT scans, problems (such as unnecessary health risks for the patients and irrational workload for the personnel), and ways of protocol standardization need to be assessed. (6–8) Aims and Objectives The aim of this study was to evaluate the significance and validity of CT scanning protocols used for PP in The Hospital of Lithuanian University of Health Sciences Kaunas clinic (HLUHS KC). We distinguished multiple objectives: 1. To assess the most prevalent traumatic CT scan findings in PP. 2. To evaluate the efficacy and rationality of using three-sequential CT scans for PP. 3. To assess the CT scan determined iatrogenic radiation doses and changes in oncogenic risk for PP. 4. To assess the workload of the radiologist when evaluating CT scans of PP. Materials and methods This was a retrospective study that included PP (n = [...].