AJR: CT may be unnecessary in stable blunt force trauma patients

The clinical yield of chest, abdomen and pelvis CT among patients presenting to the emergency department (ED) after motorized blunt force trauma and with normal clinical exams was low and did not alter clinical management, according to a study published in the December issue of the American Journal of Roentgenology.

With the escalating use of CT in the ED and accompanying cost and radiation exposure concerns, Noam Ze’ev Millo, MD, from the department of radiology and diagnostic imaging at University of Alberta in Edmonton, Canada, and colleagues sought to determine the frequency of clinically significant findings on CT of the chest, abdomen and pelvis in adults involved in motor vehicle trauma.

“Although literature findings are mixed, several recent studies support the conclusion that a certain percentage of CT scans in trauma patients are unnecessary and that carefully selected criteria can help in determining the necessity of further imaging in these patients,” wrote Millo et al.

The researchers conducted a retrospective review of 108 hemodynamically stable patients who underwent CT following motorized blunt force trauma from January 2007 to January 2010.

Although CT detected acute injuries in 10 percent of these patients, none required direct medical intervention. Two of these patients were admitted to the hospital solely for observation or pain control of entities found via CT, according to the authors.

Millo and colleagues reported incidental findings leading to recommendations for further investigations in 12 patients.

Alcohol intoxication or distracting injuries were present in eight of the 11 patients with CT findings discordant with the physical exam. Such patients, wrote the authors, represent a unique subset as injuries may remain clinically occult in this population. Millo and colleagues recommended a larger prospective study rather than a practice change to assess the needs of this population.

The researchers suggested that extended clinical observation with serial physical exams might suffice as an alternative to CT in some cases.

They concluded, “In combination with existing literature, these findings suggest that a specific set of clinical criteria may be able to reliably identify individuals for whom CT will not affect immediate medical management.” However, Millo et al acknowledged that the study did not consider other benefits of CT such as time savings, facilitation of patient triage and management and the reassurance of a negative imaging study.