Short Attention Span Summary
Why an anesthesia journal?
Overall diagnostic accuracy of clinical judgment to determine if a serious or critical lesion was present in patients with high energy blunt trauma vs whole body CT wasn't that great (AUC 0.7). However, no patient with a completely normal physical exam had a serious injury on CT (N = 19). This study was small and single center. Though we should proceed with caution until this is replicated in a larger, multi-center study, it suggests whole body CT may be omitted if the clinical examination is completely normal. Your bedside assessment really matters.
Clinical judgment alone was not very accurate in predicting serious injury compared with whole-body CT. However, patients with a completely normal exam were unlikely to have anything serious found on CT.
Clinical Judgment Is Not Reliable for Reducing Whole-body Computed Tomography Scanning after Isolated High-energy Blunt Trauma. Anesthesiology. 2017 Mar 27. doi: 10.1097/ALN.0000000000001617. [Epub ahead of print]
- My favorite commentary on the overuse of imaging was from BMJ called VOMIT - victims of modern imaging technology. Worth a read.
- This study we did a few years ago was strikingly similar. This sounds familiar.