Markus Koerner MD, Presenter: Nothing to Disclose

Michael Krotz, Abstract Co-Author: Nothing to Disclose

Oliver Gluecks MS, Abstract Co-Author: Nothing to Disclose

Klaus-Juergen Pfeifer MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Ulrich Linsenmaier MD, Abstract Co-Author: Nothing to Disclose

To evaluate the frequency and type of lesions that were not reported by the initial whole body MDCT scan in patients with multiple trauma.

In a continuous series 316 patients (mean age: 42.3 years) with a mean ISS of 28 were included. All patients underwent a full trauma whole body MDCT (head to symphysis) with a 4-slice scanner. The final reports of the initial CT were retrospectively compared to the discharge diagnoses, ICU and operation reports. Discrepant or missing findings were analyzed for technical or diagnostic errors by reevaluating the CT studies and grouped into (1) relevant and (2) not relevant for further treatment. Lesions that were not located within the scan volume, e.g. lower extremity fractures, were excluded.

In 284/316 patients (89.9%), all injuries were correctly diagnosed by the initial whole body CT report. In 32/316 patients (10.2%) lesions that were not reported were present. 16 patients (5.1%) had lesions of minor clinical importance and did not require any further treatment. However, in 16 patients (5.1%) injuries were overlooked that required further treatment. 43/316 patients (13.6%) had injuries in body regions that were not included in the CT scan volume. Relevant lesions overlooked included rupture of bladder and small bowel, contusions of pancreas and colon, renal infarction, pneumomediastinum, pneumothorax, 1 serial rib fracture, 2 sacrum and 2 mandible fractures. With secondary image interpretation, all lesions but the pancreatic and colonic contusion (93.8%) could have been diagnosed from the primary CT dataset.

In about 5%, clinical relevant lesions in patients with multiple trauma were overlooked by the initial whole body CT. However, secondary CT film reading revealed most of those injuries and can serve to improve diagnostic quality.

Secondary image reading in patients with multiple trauma helps to identify lesions that were not detected in the inital CT report.

Koerner, M, Krotz, M, Gluecks, O, Pfeifer, K, Reiser, M, Linsenmaier, U, Whole Body MDCT in Patients with Multiple Trauma: Analysis of Diagnostic Error by Primarily Overlooked Lesions.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011390.html