Spoon Feed Ultralow-dose chest CT (ULCT) had perfect diagnostic accuracy for minor traumatic injury to the chest. It was superior to plain CXR and delivered the same, or in several cases, a lower radiation dose.
Why does this matter? We often obtain a CXR in patients with blunt thoracic trauma as a screening tool. But as CT technology improves, lower-dose techniques may more accurately detect injuries with the same or lower radiation dose than an x-ray. Is that the case here?
CT vs. x-ray = same radiation dose? Yup… This was a comparison of patients with chest trauma that were hemodynamically stable and had traditional CXR +/- rib series and ULCT. CT was done with a 64 slice scanner without contrast, with iterative reconstruction (which reduces the “noise” from a lower dose scan). A reference CT, with a 1-2 mSv dose, was also done and read by the radiologists in real time as the gold standard. ULCT performed perfectly, with sensitivity 100%, specificity 100% for detecting all patients with at least one finding on reference CT, with no false positives. Plain x-ray had sensitivity 79%, specificity 89%. The radiation dose of ULCT was the same or lower than plain x-ray. ULCT is more expensive than x-ray. It also may or may not change management to find a small pneumothorax, hemothorax, or a couple rib fractures, but it depends. Might it be best to use ULCT instead of CXR in patients for whom we want to screen but not do a full trauma CT chest?
Here are two example images from the supplemental material.
Spoon FeedPOCUS in the ED can lead to clinically useful information, although research has not yet demonstrated patient-centered improvements in care. While this modality shouldn’t be used for routine screening in the ED, it performs well with a focused clinical question. Sources - PoCUS: Just because we can doesn't mean we should. Acad Emerg Med. 2022 Apr;29(4):515-517. doi: 10.1111/acem.14474. Epub…
Spoon FeedMechanism of injury and special consideration criteria are important in predicting trauma severity, but some criteria need to be dropped and others added to current field triage guidelines. SourceMechanism of Injury and Special Considerations as Predictive of Serious Injury: A Systematic Review. Acad Emerg Med. 2022 Mar 23. doi: 10.1111/acem.14489. Online ahead of print.
Spoon FeedComputed tomography pulmonary angiography (CTPA) yields an alternative diagnosis to pulmonary embolism (PE) in ~40% of patients with a negative PE study. Alternative diagnoses are more likely to occur in patients with increased age and in patients referred from the hospital setting (ICU or inpatient unit). SourcePrevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective…
Spoon FeedIn the prehospital setting, prolonged on-scene times were associated with increased 24-hour and 30-day mortality for moderately or severely injured, undifferentiated trauma patients. SourceThe impact of prehospital time intervals on mortality in moderately and severely injured patients. J Trauma Acute Care Surg. 2022;92(3):520-527. doi:10.1097/TA.0000000000003380