Noam Z. Millo MD, Presenter: Nothing to Disclose

Chris Plewes BSC , Abstract Co-Author: Nothing to Disclose

Gavin Low MBChB, MRCS, FRCR, Abstract Co-Author: Nothing to Disclose

Brian H Rowe MD, MSc, Abstract Co-Author: Nothing to Disclose

Computed Tomography (CT) has become a powerful tool in the assessment of injuries in patients with a history of blunt force trauma. Not surprisingly, utilization of CT in this setting has increased rapidly. The study will evaluate whether CT is indicated in assessing hemodynamically stable patients without evidence of injury on physical examination, solely based on mechanism of injury.

Patients presenting to the University of Alberta Hospital with a triage history of motorized blunt force trauma (from the emergency department hospital record system: key words = “motor vehicle, MVC, MVA, ATV, motorcycle, snowmobile, car versus ped”) presenting between June 2007 and January 2009 who underwent CT of the chest, abdomen and pelvis at the time of presentation were the subjects of chart review. Only patients who were hemodynamically stable (Hemoglobin ≥ 120, GCS ≥ 14, Systolic Blood Pressure ≥ 90, Heart Rate = 60-100; Oxygen Saturation >92%; Respiratory Rate ≤ 24), and without abnormal physical examination findings to suggest injury of the trunk (e.g., tenderness, deformity, or bruising over the chest, abdomen or pelvis) were included in the study. In patients that met the inclusion criteria, findings from the CT report were reviewed.

71 patients formed the study population. The mean age was 36 years. 72% of patients were male. 71% were involved in motor vehicle collisions, 7% motorcycle accidents, 13% all-terrain vehicle accidents, and 9% were car versus pedestrian injuries. 87% of patients had no injuries detected on CT. Detected injuries were as follows: five patients had rib fractures, and two patients had small pneumothoraces not requiring chest tubes. Pulmonary contusions were detected in two patients. Two patients had isolated transverse process fractures. One patient had a small contained liver laceration. None of the detected injuries required any direct intervention. 66% of injuries were in patients with alcohol intoxication.

In the setting of motorized blunt force trauma, CT is unlikely to detect injuries requiring intervention in stable patients without significant physical exam findings. In this study, no injuries requiring intervention were detected.

CT of the chest abdomen and pelvis is unlikely to affect management in hemodynamically stable patients without significant physical exam findings following motorized blunt force trauma. 

Millo, N, Plewes, C, Low, G, Rowe, B, Appropriateness of CT of the Chest, Abdomen, and Pelvis in Motorized Blunt Force Trauma Patients without Signs of Serious Injury.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003349.html