The role of the radiologist in the management of politrauma patients

The management of trauma patients has become a very relevant issue and one of the major challenges in the western countries. In the assessment of politrauma patients, since the last 2 decades, radiological imaging methods have been increasingly used in order to provide a quick and thorough survey of craniocerebral, cervical, abdominal, pelvic and limb traumatic injuries. Among imaging methods, conventional radiographs (CR) have precise but limited indications. In most European hospitals, UltraSonography (US) represents the method of choice for patients referred following blunt abdominal trauma, whereas multislice computed tomography (MSCT) remains a second-line method of investigation, although it provides a fully comprehensive assessment of their injuries and allows for their categorization according to the severity of traumatic injuries. In fact, injury prevalence, radiation dose exposure, and costs represent important considerations in all of the emergency departments, where a growing number of patients seeking medical attention is seen. The radiologist's task is to decide which imaging method is mostly appropriate after initial patient presentation. In the severe politrauma patient, the diagnostic endpoint is to identify the nature and extent of the various injuries in order to execute a more tailored therapeutic approach: this is the patient in whom a total-body MSCT has to be performed in order to provide rapid and accurate information for a correct management. In the large majority of our patients, who do not show the need for a formal hospital admission, after the physical examination has revealed the clinical suspicion of minimal single-organ injury, US provides an adequate assessment of abdominal traumatic injuries and triage those few who are subsequently to be evaluated by means of MSCT. In the majority of this patients category, with low to very-low grade of potential injuries, CR can detect all types of skeletal fractures (except for the skull and the hips). Overall, the role of the emergency radiologist has become of primary importance in the management of trauma patients, and this all the more so since development of interventional radiology affords therapeutic procedures alternative to surgery. (C) 2006 Elsevier Ireland Ltd. All rights reserved.