Development of an accelerated MSCT protocol (Triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients

During multiple casualty incidents (MCI) emergency radiology departments have to deal with a large number of patients with suspected severe trauma within a short period of time. The aim of this study was to develop a suitable accelerated multislice computed tomography (MSCT) protocol to increase patient throughput for this kind of emergency situation. We presumed a scenario of 15 patients being admitted to the trauma service with suspicion of severe injuries after a MCI over a period of 2 h. An accelerated Triage MSCT protocol was developed and evaluated for MSCT scanner productivity (patients per hour) and time (minutes) needed for a total MSCT body workup using an anthropomorphic phantom. In addition, time (minutes) for transfer and preparation was measured. These timeframes were compared to a control group consisting of 144 single patients with multiple trauma undergoing standard MSCT according to our trauma room protocol. All MSCT studies were conducted using a 4-detector row scanner. (1) For the study group (Triage MSCT), average time for patient transfer and preparation was 2.9 min (2.5–4.3 min), mean CT examination time was 2.1 min (1.7–2.4 min); image reconstruction took 4.0 min (3.3–4.3 min). Total time in scanner room was 8.9 min (7.7–11.3 min), resulting in a maximal productivity of 6.7 patients per hour. Image transfer to the digital picture archive and communication system archive was completed after an average 9.5 min (8.9–10.8 min). (2) For the control group (single casualty MSCT), the mean time for patient transfer and preparation was 20.4 min (9.0–39.2 min), mean examination time was 6.0 min (3.1–11.3 min). Times for image reconstructions were not recorded in the patient series. Mean total time in scanner room was 25.3 min (11.0–72.4 min), resulting in a patient throughput of 2.4 patients per hour. MSCT has potential to serve as a powerful tool in triage of multiple casualty patients. The introduction of a Triage MSCT scanning protocol resulted in an increase of patient throughput per hour by a factor of almost 3.