Lucas L Geyer MD, Presenter: Nothing to Disclose

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

Stefan Wirth MD, Abstract Co-Author: Nothing to Disclose

Karl-Georg Kanz MD, Abstract Co-Author: Nothing to Disclose

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

Markus Koerner MD, Abstract Co-Author: Research grant, General Electric Company Speakers Bureau, General Electric Company

To investigate whether a quick emergency evaluation of two-plane scouts of whole-body CT in multiple injured patients is useful for preliminary evaluation of traumatic injuries and correct tube placement before CT images are available for final reading.

108 two-plane scouts were retrospectively assessed for the following acute findings: tube displacement, pneumothorax, fractures of the ribs, pelvic girdle, thoracolumbar spine, and extremities. Injuries of the head, neck and abdominal organs were excluded. Image reading was performed by two blinded radiologists in consensus. CT images served as gold standard. Injuries that were identified were categorized by the abbreviated injury scale (AIS), AIS>2 was defined as cut-off. 2-by-2-tables, the Chi-square test and Fisher’s exact test were used for statistical testing.

39/108 (36%) scouts were assessed as pathologic; in 50/108 (46%) patients CT showed at least one traumatic lesion, 28/50 (56%) had at least one injury with AIS>2. Sensitivity, specificity and PPV, and NPV were: overall 74%, 97%, 95%, 81%; tube displacement 100 %; pneumothoraces 75%, 100%, 100%, 98%; rib fractures 38%, 100%, 100%, 87%; pelvic fractures 64%, 98%, 78%, 96%; spine fractures 25%, 99%, 80%, 88%; injuries of the extremities 61%, 95%, 83%, 86%. For serious injured patients (AIS>2) the test characteristics were better with 93%, 84%, 67%, 97% with a significant correlation (p<0.001). All relevant pneumothoraces and traumatic bony lesions of the pelvis with an AIS>2 were correctly identified on the scouts. Non-displaced fractures and suboptimal patient positioning mainly impaired the sensitivity for injuries of the thorax, extremities, and spine.

Although CT is the gold standard in trauma imaging, scout views can serve as excellent diagnostic adjunct for preliminary evaluation of traumatic injuries and correct tube placement. A structured reading of the scout can safely identify acute pathologies, which allow for immediate changes in clinical treatment, such as chest tube placement or correction of a displaced endotracheal tube necessary before CT images are available for final image reading.

Scout views can be used for detection of pathologies in patients with multiple trauma, which need immediate intervention such as chest tube placement or correction of a displaced endotracheal tube.

Geyer, L, Linsenmaier, U, Wirth, S, Kanz, K, Reiser, M, Koerner, M, Diagnostic Value of Two-plane CT Scout Views for Preliminary Emergency Evaluation of Traumatic Injuries and Correct Tube Placement prior to Whole-Body MDCT Imaging in Major Trauma.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009865.html