Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims

AIM: To assess the accuracy of the trauma team leader's clinical suspicion of injury in patients who have undergone whole-body computed tomography (WBCT) for suspected polytrauma, and to assess the frequency of unsuspected injuries and specific patterns of injury at WBCT. MATERIALS AND METHODS: Requests for patients who underwent WBCT for suspected polytrauma from April 2011 to March 2014 were reviewed and each body area that was clinically suspected to be injured was recorded. Body areas were divided into the following groups based on anatomical regions covered in each segment of the WBCT examination: head (including facial bones); neck (including cervical spine); chest (including thoracic spine); and abdomen/pelvis (including lumbar spine). The formal radiology report for each study was reviewed and injuries found at CT were grouped into the same body areas. For each patient, the number of clinically suspected injured areas was compared to the number of confirmed injured areas at WBCT. RESULTS: Five hundred and eighty-eight patients were included in the study. Thirty-two percent (186/588) had a normal scan. Ninety-three percent (546/588) had fewer injured body areas at WBCT than suspected. Four percent (27/588) had the equivalent number of injured areas at WBCT as suspected. Three percent (15/588) had more injured areas at WBCT than suspected. Fifty percent (263/527) with clinically suspected chest injuries were confirmed to have chest injuries at WBCT. This was lower for other areas: abdomen/pelvis 31% (165/535); head 29% (155/533); neck 13% (66/513). Four percent of (24/588) patients had unsuspected injuries found at WBCT. Seventy-five percent (18/24) of unsuspected injuries were considered as serious, where failure to treat would have the potential for significant morbidity. Most of these patients had severe injuries to other body areas that were correctly suspected. Of the 165 with abdominal/pelvic region injuries, there were associated injuries in the thoracic region in 62% (103/165) cases. Of the 278 thoracic injuries, there were abdominal/pelvic region injuries in 37% (103/278) and injuries to the neck in 19% (52/278) cases. Of the 158 head injuries, there were neck injuries in 22% (34/158) cases. CONCLUSION: Clinical suspicion of injury correlates poorly with findings at WBCT, with a high proportion of uninjured body areas. The number of unsuspected injuries found at WBCT was low, but the majority of these were serious injuries, possibly masked by distracting injury to other body areas. The use of a WBCT protocol is recommended for suspected polytrauma, but regular monitoring of WBCT findings and regular feedback of the results to emergency physicians is suggested to help inform their selection of patients for trauma WBCT. (C) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.