Clinical Judgment in Major Trauma

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.

Spoon Feed
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.

Source/Another Spoonful
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]

 

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