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01-02-2022 | Original Article

Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients

Authors: Elisa Reitano, Stefano Granieri, Fabrizio Sammartano, Stefania Cimbanassi, Miriam Galati, Shailvi Gupta, Angelo Vanzulli, Osvaldo Chiara

Published in: Updates in Surgery | Issue 1/2022

Abstract

High energy blunt trauma patients with normal vital signs are usually investigated with a Contrast Enhanced Computed Tomography (CECT) for torso injuries. CECT involves high levels of radiations, often showing no injuries in patients over-triaged to the trauma center. The aim of our study was to suggest an alternative diagnostic protocol based on Emergency Room (ER) tests (physical exam, blood tests, extended FAST, Chest and Pelvis X-ray) to avoid CECT in selected patients. A prospective cohort study was conducted from September 2018 to September 2019. Five hundred patients fulfilled the inclusion criteria. Patients received torso-CECT scan only if they had at least one positive ER test. The validity of the single component of the protocol and the global validity of the ER tests to detect torso injuries was assessed through sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, positive (+ LR) and negative (− LR) likelihood ratio. Multivariate analysis was performed to identify independent predictors of torso injuries. One hundred and seventy patients received a torso-CECT scan because of positive ER tests. ER tests showed a global sensitivity for torso injuries of 86.96% (95% CI 80.17–92.08) specificity of 83.98%(95% CI 79.79–87.60), PPV of 67.42% (95% CI 61.83–72.54), NPV of 94.41% (95% CI 91.63–96.30) + LR of 5.43 (95% CI 4.25–6.93), − LR of 0.16 (95% CI 0.10–0.24). ER tests in an experienced center seem to be able to identify more severe blunt trauma patients needing CECT. Further studies are advisable to confirm these results.

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Title: Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients
Authors: Elisa Reitano
Stefano Granieri
Fabrizio Sammartano
Stefania Cimbanassi
Miriam Galati
Shailvi Gupta
Angelo Vanzulli
Osvaldo Chiara
Publication date: 01-02-2022
Publisher: Springer International Publishing
Published in: Updates in Surgery / Issue 1/2022
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01199-w

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Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients

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