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Whole-body CT

Robert Crochelt robertc at searhc.org
Fri Jan 27 19:14:55 GMT 2012

I believe these guidelines will be helpful to providers in local hospitals.

Bob Crochelt

On Fri, Jan 27, 2012 at 5:12 AM, Bjorn, Pret <pbjorn at emh.org> wrote:

> BIG 'AYUH' from Maine.  Our EMS Trauma Advisory Committee is preparing
> this guideline (attached, currently in draft) for addition to our other
> online advice to trauma system providers.  Comments or suggestions welcome.
> Pret Bjorn, RN
> Bangor, ME USA
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
> Sent: Tuesday, January 24, 2012 8:21 PM
> To: trauma-list at trauma.org
> Subject: Re: Whole-body CT
>  Any test, including lab tests, routine X-rays, CT scans, etc, should
> trongly believe that ONLY be done if the person ordering the test can write
> a progress note stipulating what it is that they expect to find from the
> test and  how the results will influence decision making compared to if the
> test
> was NEVER  performed.      With such a rule, more  than  85-92% of all
> tests,
> especially CT scans for trauma, appendicitis, etc. etc.  would be
> eliminated.
> I stongly believe that our over reliance on CT scaning, especially CT
> Angiography contributes to VOMIT - Victim of Modern Imaging Technology from
> false positive and over read CT scans.    AND I do believe that  society
> will
> hold the medical profession accountable for this excessive  radiation, and
> excessive costs.
> k
> In a message dated 1/24/2012 6:19:48 P.M. Central Standard Time,
> dnepogodiev at googlemail.com writes:
> Dear  trauma.org members,
> I'd be very interested in the list's expert views  on CT abdomen in
> trauma. It comes after an article in the Lancet from 2009  that concluded
> that between 17 and 32 trauma patients need to undergo  whole-body CT to
> prevent one trauma death. Clearly there is a need to  weigh up the costs
> and radiation exposure of CT against their  benefits.
> Major unstable polytrauma patient with positive abdominal  signs =
> theatre. And major trauma patients who are stable but have a  tender
> abdomen = CT. I wonder whether the haemodynamically stable, awake patient
> with, say, a broken clavicle, broken ankle and non-tender abdomen needs a
> whole-body CT? What about long bone fractures, e.g.
> femur, but still asymptomatic abdomen? Is a distracting injury a valid
> indication?
> In trauma, should CT scans of the abdomen be performed  on awake,
> non-agitated patients with asymptomatic abdomens, but who have  positive
> mechanism of injury/ other injuries? Or should CT abdomen be  reserved for
> the symptomatic abdomen/ intubated patient? What does the  list feel is an
> acceptable “number needed to treat” of patients scanned to  prevent one
> death/ result in one surgical  intervention?
> Huber-Wagner, S., R. Lefering, et al. (2009). "Effect of  whole-body CT
> during trauma resuscitation on survival: a retrospective,  multicentre
> study." Lancet 373(9673): 1455-1461.
> With many thanks  for your thoughts.
> Dmitri, University of Birmingham,  UK
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Bob Crochelt, MD, PhD, FACS
Chief of Surgery
Mt. Edgecumbe Hospital
Sitka, Alaska, USA

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