Abstracts and Poster Abstracts of the Annual Scientific Meeting and Postgraduate Course of the American Society of Emergency Radiology

Abstract

Abstracts and Poster Abstracts of the Annual Scientific Meeting and Postgraduate Course of the American Society of Emergency Radiologys and Poster Abstracts of the Annual Scientific Meeting and Postgraduate Course of the American Society of Emergency Radiology 27–30 September 2006, Washington, DC, USA Published online: 8 August 2006 # Am Soc Emergency Radiol 2006 Abstract No Scientific Session 1–16 Scientific Posters 1–23No Scientific Session 1–16 Scientific Posters 1–23 Abstract 1 CONSEQUENCE OF PRIMARY WHOLE BODY MSCT ON MORTALITY IN MAJOR TRAUMA1 CONSEQUENCE OF PRIMARY WHOLE BODY MSCT ON MORTALITY IN MAJOR TRAUMA Markus Körner, MD Munich University Hospital, Dept. of Surgery, Munich, Germany Munich University Hospital, Dept. of Clinical Radiology, Munich, Germany Purpose: According to advanced trauma life support (ATLS) standards, computed tomography (CT) serves as a second line diagnostic modality subsequent trauma resuscitation. However some trauma centres use CT as a diagnostic tool for primary trauma survey even in haemodynamically unstable patients. At this point there is no published data analysing the effect of this approach on the outcome. Materials & Methods: The prospectively data of 9,689 major trauma patients taken from the trauma registry hosted by the German Association for Trauma Surgery (DGU) from 2002 to 2004 was analyzed. Inclusion criteria were primary hospital admission, Injury Severity Score (ISS) & #8805; 16 and available information on computed tomography (CT) and mortality. Trauma and Injury Severity Score (TRISS) and Revised Injury Severity Classification Score (RISC) were calculated, predicted and actual survival was analyzed for whole body multislice computed tomography (WB-MSCT) versus selective organ CT (SO-CT). Results: A total of 4,817 cases met the inclusion criteria. WB-MSCT during primary trauma survey was performed in 1,535 patients. 3,282 patients received SO-CT after primary survey completion including focussed ultrasound and plain radiography. While the unadjusted mortality of the WB-MSCT group of 20.6% was lower than the mortality of the SO-CT group with 22.5%, the WB-MSCT group presented with a higher mean ISS of 32.5 1 13.8 compared to the SO-CT group with 28.5 1 12.7 (p< 0.001). Using TRISS calculation standardized mortality rate (SMR) of the WB-MSCT was reduced to 0.74 compared to SO-CT with 1.02 (p< 0.001), using RISC calculation SMR was reduced to 0.87 compared to 1.05 (p =.018). Conclusion: The integration of multi-slice computed tomography in primary trauma treatment protocols reduces mortality in major trauma patients between 13% (RISC) and 26% (TRISS). Abstract 2 STANDARD ABDOMINAL MDCT AFTER BLUNT TRAUMA: EVALUATION OF ADDITIONAL FINDINGS AND IMPACT ON PATIENT MANAGEMENT. PRELIMINARY RESULTS OF A PROSPECTIVE STUDY2 STANDARD ABDOMINAL MDCT AFTER BLUNT TRAUMA: EVALUATION OF ADDITIONAL FINDINGS AND IMPACT ON PATIENT MANAGEMENT. PRELIMINARY RESULTS OF A PROSPECTIVE STUDY Monique Brink, MD Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Purpose: The purpose of this study is to evaluate the additional diagnostic value of either selective or routine Multi detector CT of abdomen, pelvis and lumbar spine (abdominal MDCT), as compared to conventional radiology in blunt trauma patients. Methods: A prospective cohort study was conducted in trauma patients of 16 years and older that were primarily referred to our emergency department. As a part of an integral diagnostic protocol for all patients that met criteria indicative for high-energy blunt trauma, diagnostic work up consisted of 1) clinical evaluation, 2) focused abdominal ultrasound for trauma (FAST), 3) conventional radiography of pelvis (PCR) and lumbar spine (LCR) and 4) abdominal MDCTwith intravenous contrast agent. All patients had the same standardized MDCT protocol. However, we prospectively recorded if abdominal MDCT was either requested as a routine trauma screening investigation, or as a selective supplement to abnormal or inconclusive clinical or conventional radiological evaluation. Type and extent of injuries (signs of visceral injury, vertebraland pelvic fractures) was determined on MDCT and compared to conventional radiological imaging i.e. FAST, PCR and LCR. In addition, impact of these additional findings on patient management was recorded. Results: From May 2005 until May 2006, 324 patients (213 men and 111 women) were enrolled: their mean age was 39 years. 112 patients had selective abdominal MDCT. 68(61%) selective MDCTs were abnormal. 40(36%) detected more additional diagnoses compared to conventional radiology; these altered patient management in 24 cases (21%). Of 212 routine abdominal MDCTs, 36(17%) detected injuries; 29(14%) found more injuries than suspected on conventional radiology. This altered patient management in 11(5%) patients; in 7 cases because of unexpected visceral injuries, in 4 cases because of additional lumbar fractures. However, there was no additional pelvic finding that affected patient management. Conclusion: In this prospective study, preliminary results show that even in blunt trauma patients with normal clinical evaluation and normal conventional radiological imaging, a routine abdominal MDCT shows incremental visualization of clinically relevant visceral and lumbar injuries. Abstract 3 THE DIAGNOSTIC VALUE OF STANDARD MDCT OF THE CHEST AFTER BLUNT TRAUMA. PRELIMINARY RESULTS OF A PROSPECTIVE EVALUATION3 THE DIAGNOSTIC VALUE OF STANDARD MDCT OF THE CHEST AFTER BLUNT TRAUMA. PRELIMINARY RESULTS OF A PROSPECTIVE EVALUATION Monique Brink, MD Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Purpose: Controversy remains on indications for Multi Detector Computed Tomography of the chest (chest MDCT) as a standard diagnostic tool after blunt trauma. The purpose of this study is to evaluate the additional diagnostic value of 1) selective chest MDCT or 2) standard chest MDCT as compared to plain chest radiography in blunt trauma patients. Methods: A prospective cohort study was conducted in blunt trauma patients of 16 years and older that met criteria for our diagnostic high energy trauma protocol. These criteria were either life-threatening problems in airway patency, breathing, circulation and/or neurological problems, specific high impact injuries and/or high-energy mechanism of trauma. Exclusion criteria were uncorrectable shock, neurosurgical emergency or pregnancy. According to the protocol, patients underwent 1) clinical evaluation, 2) plain chest radiography and 3) chest MDCT with intravenous contrast agent. All patients had the same CT protocol, but we prospectively recorded if this CT was either requested as a routine trauma screening investigation, or as a selective supplement to previous abnormal findings in clinical evaluation and radiography. Type and extent of chest injuries (pneumothorax, hemothorax, pulmonary contusion, presence of rib-, scapularand sternal fractures, signs of diaphragm rupture and vascular injury) were determined on chest MDCT (standard of reference) and compared to plain chest radiography. Results: From May 2005 until May 2006, 324 patients were enrolled in the protocol: 213 men and 111 women with a mean age of 39 years old. In 60 patients with selective chest MDCT, 54 MDCTs (90%) were abnormal, and detected more injuries than plain radiography in 45 patients (75%). Of all 264 routine MDCTs, 104 MDCTs (39%) were abnormal, and detected additional injuries in 94 patients (36%). In this group, most additional diagnoses were pulmonary contusion in 54(20%), rib fractures in 29 (11%) and pneumothorax in 30(11%) routine MDCTs. Conclusion: In this prospective cohort study, our preliminary results show incremental visualization of traumatic thoracic injuries on MDCT compared to plain radiography in blunt trauma patients, even in patients who are unsuspected for significant injury on conventional evaluation. Abstract 4 BENCHMARKING OUR LEAN APPROACH TO CERVICAL SPINE IMAGING IN A PEDIATRIC AND ADULT LEVEL 1 TRAUMA CENTER4 BENCHMARKING OUR LEAN APPROACH TO CERVICAL SPINE IMAGING IN A PEDIATRIC AND ADULT LEVEL 1 TRAUMA CENTER Caroline E. Blane, MD University of Michigan, Ann Arbor, MI, USA Purpose: To expedite cervical spine management we changed from initial plain radiography to initial CT imaging in a designated group of ED patients in our Level 1 Trauma ED. The purpose of this study was to document any change in numbers and types of fractures diagnosed. Methods: Study was IRB approved. We benchmarked cervical spine imaging against the NEXUS data before and after new criteria for initial imaging of selected populations with CT were implemented. All studies were retrieved through the RIS. Data included the age, sex, types of imaging (CT versus radiography), fractures, treatment and mechanisms of injury. Results: Age range of the pre-implementation 1711 patients was 3 to 94 years (mean 42.9). In 646/1711 (38%) a CT was included usually after attempted plain radiography. There were 66 positive cases (3.9%), 30/66 cases (45%) or 30/1711 (1.8%) required intervention. 45/66 (68.2 %) of the positive cases were age<50. Fractures were identified on plain film radiography alone 287

DOI: 10.1007/s10140-006-0522-8

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@article{Krner2006AbstractsAP, title={Abstracts and Poster Abstracts of the Annual Scientific Meeting and Postgraduate Course of the American Society of Emergency Radiology}, author={Markus K{\"{o}rner and Monique Brink}, journal={Emergency Radiology}, year={2006}, volume={12}, pages={286-300} }