Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan.

In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients.

Improving Outcomes in the Patient with Polytrauma: A Review of the Role of Whole-Body Computed Tomography.

Whole-body computed tomography (WBCT) is used for the workup of the patient with blunt polytrauma. WBCT is associated with improved patient survival and reduces the emergency department length of stay. However, randomized studies are needed to determine whether early WBCT improves survival, to clarify which patients benefit the most, and to model the costs of this technique compared with traditional workup.

Thoracoabdominal computed tomography in trauma patients: a cost-consequences analysis.

Background: CT is increasingly used during the initial evaluation of blunt trauma patients. In this era of increasing cost-awareness, the pros and cons of CT have to be assessed.

Objectives: This study was performed to evaluate cost-consequences of different diagnostic algorithms that use thoracoabdominal CT in primary evaluation of adult patients with high-energy blunt trauma.

Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients.

Background: Trauma is the fifth leading cause of death worldwide, and in people younger than 40 years of age, it is the leading cause of death. During the resuscitation of trauma patients at the emergency department, there are two different commonly used diagnostic strategies. Conventionally, there is the use of physical examination and conventional diagnostic imaging, potentially followed by selective use of computed tomography (CT).

An evidence based blunt trauma protocol.

Objective: Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this study's aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt high-energy trauma patients, especially for the use of CT.

Methods: An evidence-based flow chart was created with criteria based on trauma mechanism, physical examination and laboratory analyses to indicate appropriateness of conventional radiography (CR), sonography and CT of head, cervical spine and trunk.

Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients.

Background: Currently, total body computed tomography (TBCT) is rapidly implemented in the evaluation of trauma patients. With this review, we aim to evaluate the clinical implications-mortality, change in treatment, and time management-of the routine use of TBCT in adult blunt high-energy trauma patients compared with a conservative approach with the use of conventional radiography, ultrasound, and selective computed tomography.

Methods: A literature search for original studies on TBCT in blunt high-energy trauma patients was performed.

Incidental Findings on Routine Thoracoabdominal Computed Tomography in Blunt Trauma Patients.

BACKGROUND:: Thoracoabdominal MultiDetector-row Computed Tomography (MDCT) is frequently used as a diagnostic tool in trauma patients. One potential side-effect of performing MDCT is the detection of incidental findings and their subsequent consequences on medical treatment. The objective was to evaluate frequency and effects of incidental findings in trauma patients.

The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients.

Background: Multidetector-row computed tomography (MDCT) is a more sensitive modality as compared with conventional radiography (CR) in detecting pulmonary injuries. MDCT often detects pulmonary contusion that is not visualized by CR, defined as occult pulmonary contusion (OPC). The aim of this study was to investigate whether OPC on MDCT has implications for the outcome in blunt trauma patients.

Minor head injury: CT-based strategies for management--a cost-effectiveness analysis.

Purpose: To compare the cost-effectiveness of using selective computed tomographic (CT) strategies with that of performing CT in all patients with minor head injury (MHI).

Materials And Methods: The internal review board approved the study; written informed consent was obtained from all interviewed patients. Five strategies were evaluated, with CT performed in all patients with MHI; selectively according to the New Orleans criteria (NOC), Canadian CT head rule (CCHR), or CT in head injury patients (CHIP) rule; or in no patients.

Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm.

Objective: To select parameters that can predict which patients should receive abdominal computed tomography (CT) after high-energy blunt trauma.

Summary Background Data: Abdominal CT accurately detects injuries of the abdomen, pelvis, and lumbar spine, but has important disadvantages. More evidence for an appropriate patient selection for CT is required.

Management of Thyroid Gland Hemorrhage After Blunt Trauma: A Case Report and Review of the Literature.

Background: Thyroid hemorrhage is a rare injury in patients suffering from blunt trauma to the neck. The case of a 60-year-oldwoman is describedwho developed increasing swelling in the neck with a mild inspiratory stridor after a fall from her bed. The fall had resulted in hemorrhage within a previously existing goiter.

Routine versus selective multidetector-row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management.

Introduction: This study was performed to determine the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective multidetector-row computed tomography (MDCT) findings in blunt trauma patients.

Patients: For this study, 50 patients were randomly selected from a customized database that was originally used to compare a diagnostic algorithm with a selective use of MDCT with an algorithm with routine MDCT of the spine, chest, and abdomen within the same population. In all 50 patients, routine MDCT found additional diagnoses as compared with the selective MDCT algorithm.

Is a pelvic fracture a predictor for thoracolumbar spine fractures after blunt trauma?

Background: Discussion still remains which polytraumatized patients require radiologic thoracolumbar spine (TL spine) screening. The purpose of this study is to determine whether pelvic fractures are associated with TL spine fractures after a blunt trauma. Additionally, the sensitivity of conventional TL spine radiographs and pelvic radiographs (PXRs) is evaluated.

Criteria for the selective use of chest computed tomography in blunt trauma patients.

Purpose: The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury.

Methods: This observational study prospectively included consecutive patients (>or=16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre.

Results: We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT.

Routine versus selective computed tomography of the abdomen, pelvis, and lumbar spine in blunt trauma: a prospective evaluation.

Background: Discussion still remains whether computed tomography (CT) of the abdomen, pelvis, and lumbar spine should be performed routinely after blunt trauma with high energy impact or only in restricted situations. The purpose of this study was to evaluate the additional value of a routine CT algorithm as compared with a more restricted, selective CT algorithm.

Materials: This prospective study consisted of 465 patients that met the inclusion criteria of our high-energy trauma protocol.

Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose.

Purpose: To evaluate the effect of arm position on image quality and effective radiation dose in an automatic exposure-controlled (AEC) multidetector thoracoabdominal computed tomography (CT) protocol in trauma patients.

Materials And Methods: This retrospective study of the data of 177 trauma patients (117 male; median age, 39 years) was approved by the institutional ethics board, with informed patient consent waived. Patients underwent scanning by using an AEC 16-detector thoracoabdominal CT protocol in which both arms were raised above the shoulder region (standard-position group, 132 patients), one arm was raised and the other was down (one-arm group, 27 patients), or both arms were down (two-arm group, 18 patients).

Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management.

Objective: The objective of our study was to evaluate the added value of a low-threshold routine thoracic MDCT algorithm compared with a selective MDCT algorithm in adult blunt trauma patients.

Subjects And Methods: A prospective cohort study was conducted in 464 consecutive blunt trauma patients who met criteria indicative of severe blunt trauma (66% male; age range, 16-93 years; median injury severity score, 13). After clinical evaluation and conventional radiography of the chest and thoracic spine, all patients underwent routine thoracic MDCT with an IV contrast agent (routine MDCT algorithm).

Minor head injury: guidelines for the use of CT--a multicenter validation study.

Purpose: To prospectively and externally validate published national and international guidelines for the indications of computed tomography (CT) in patients with a minor head injury.

Materials And Methods: The study protocol was institutional review board approved. All patients implicitly consented to use of their deidentified data for research purposes.

Advanced Trauma Life Support. ABCDE from a radiological point of view.

Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with day to day practice and the radiological literature.

Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule.

Background: Prediction rules for patients with minor head injury suggest that the use of computed tomography (CT) may be limited to certain patients at risk for intracranial complications. These rules apply only to patients with a history of loss of consciousness, which is frequently absent.

Objective: To develop a prediction rule for the use of CT in patients with minor head injury, regardless of the presence or absence of a history of loss of consciousness.

External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury.

Context: Two decision rules for indications of computed tomography (CT) in patients with minor head injury, the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC), suggest that CT scanning may be restricted to patients with certain risk factors, which would lead to important reductions in the use of CT scans.

Objective: To validate and compare these 2 published decision rules in Dutch patients with head injuries.

Design, Setting, And Patients: A prospective multicenter study conducted between February 11, 2002, and August 31, 2004, in 4 university hospitals in the Netherlands of 3181 consecutive adult patients with minor head injury who presented with a Glasgow Coma Scale (GCS) score of 13 to 14 or with a GCS score of 15 and at least 1 risk factor.