Margaret Grant McKernan MD, Presenter: Nothing to Disclose

Carol A. Boles MD, Abstract Co-Author: Nothing to Disclose

Frank Collinson, Abstract Co-Author: Nothing to Disclose

Preston Miller MD, Abstract Co-Author: Nothing to Disclose

Gabriel Berry MD, Abstract Co-Author: Nothing to Disclose

Mitchell Harris, Abstract Co-Author: Nothing to Disclose

Scott Adams BS, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Multiple previous reports have demonstrated that reconstructed images from trauma CT of the chest and abdomen can supplant plain film evaluation of the spine in the emergency setting. However, image reconstruction requires considerable extra time either on the part of the radiologist or technologist, and can delay the prompt evaluation of the trauma patient. We examined the accuracy of detection of thoracic and lumbar fractures based solely on unreconstructed axial data from trauma-protocol CT.

A total of 101 Level I and II (severe trauma, multisystem involvement) trauma patients were scanned with standard trauma protocol CT [Multi-detector row GE CT scanner (4 slice):KV 120, mA 300, table speed 7.5mm per rotation, pitch 3. 2.5 mm axial images of the chest, 5 mm axial images of the abdomen and pelvis] over a two month period. Original reading of the scans was compared both to the patient's discharge diagnosis and blind reading by two staff radiologists and one resident.

Acute fractures were identified in 25 of 101 patients (25 %). 7 (28%) of the 25 patients had only 1-2 minimally displaced transverse process fractures. The fractures were correctly identified on the initial axial trauma CT in all but one of the 25 patients (96%). The missed fracture was a single minimally displaced transverse process fracture. Two additional patients (not included in the 25) had fractures called acute on the initial trauma scan which were later felt to be remote by dedicated imaging and clinical assessment.

Interpretation of axial images generated by trauma protocol scans of the chest and abdomen provides an accurate and rapid means of screening for thoracic and lumbar fractures; reconstruction and dedicated spine imaging can be reserved for patients with positive screening exams.

McKernan, M, Boles, C, Collinson, F, Miller, P, Berry, G, Harris, M, Adams, S, et al, , Standard Trauma-Protocol Thoracic and Abdominal CT Serves as an Effective Screening Tool for Thoracic and Lumbar Fractures.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405483.html