Role of Whole Body CT (WBCT) in Trauma Patients “Life Saver or Needless Radiation Exposure?”

Abstract

ABSTRACTBackgroundWhole-body computed tomography (WBCT) is used indiscriminately in trauma cases, just on the suspicion of them being polytrauma cases. A good clinical examination done pre-emptively could prevent the need for this investigation and its undesired radiation effects. The use of WBCT was assessed in our busy hospital to determine whether there has been an overuse of the WBCT and also to estimate the true incident of clinical injuries.MethodsRetrospective database analysis of 546 WBCT polytrauma cases for the period of April to October 2018 was performed. All the trauma patients were initially managed and proceed for WBCT according to the American College of Radiology (Major Trauma). We recorded age, gender, mechanism of injury, clinical requests, WBCT findings in regions of the cervical spine, thoracolumbar spine, chest, abdomen and pelvis skeleton injuries (as per our institutional reporting protocol), as well as DLP for each patient scanned. We compared pre-test clinical requests stating the mechanism of injury and clinical query with WBCT findings and categorized the radiological findings, initially into negative and positive findings. The positive findings were further classified into the major and minor injuries. The total numbers in each radiological finding were calculated and inferences discussed.ResultsOn analysis of data, we found that 462 patients had been referred due to RTA (84.6%), 47 patients due to FFH (8.6%), ten patients due to blunt trauma (1.8%), 8 patient due to assault (1.5%), while the 5 patients had stable wound (0.09%), five patients had injury due to the fall of a heavy object (0.09%), 3 patients had a buggy injury (0.05%), 3 patients had injury due to fallen on the back (0.05%) and 3 more patients had injury due to other traumas including blast injury, suicide and other injury. We noticed RTA with an 84.7 % score was the most common indication for WBCT referral. Out of 546 cases, 414 patients (75.8 %) were normal (negative finding), where 132 patients (24.2 %) had positive trauma related radiological finding of which 54 patients were found to have a major injury (9.9%). Fractures were scored the highest, 75.6% of all positive finding traumas.ConclusionsThis study re-emphasizes the significance of exercising a good clinical examination in the era of evidence based medicine, which would reduce the high number of unnecessary high dose WBCT, as 462 scans with no positive findings on radiological examinations were nearly normal and only 54 cases (9.9%) had major injuries.