Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

https://doi.org/10.25100/cm.v51i1.4224

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Published: Mar 2, 2020
Updated: 2020-03-02
Issue: Vol. 51 No. 1 (2020)
Section Original Articles

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Authors

  Carlos Ordoñez Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali, Colombia
  Carlos García Fundacion Valle del Lili, Radiology Department, Cali, Colombia
Michael W. Parra Department of Trauma Critical Care, Broward General Level I Trauma Center. Fort Lauderdale, FL.
  Edison Angamarca Trauma and Critical Care Surgery, Universidad del Valle. Cali, Colombia
  Mónica Guzmán-Rodríguez Fundacion Valle del Lili, Centro de Investigaciones Clínicas (CIC) , Cali, Colombia
Claudia P. Orlas Center for Surgery and Public Health, Department of Surgery, Brigham & Women’s Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health. Boston, MA.
Juan Pablo Herrera-Escobar Center for Surgery and Public Health, Department of Surgery, Brigham & Women’s Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health. Boston, MA.
Erika Rincón Fundacion Valle del Lili, Radiology Department, Cali, Colombia
Juan José Meléndez Trauma and Critical Care Surgery, Universidad del Valle. Cali, Colombia
Jose Julián Serna Fundacion Valle del Lili, Division of Trauma and Acute Care Surgery, Cali, Colombia
Natalia Padilla Universidad ICESI, Facultad de Medicina, Cali, Colombia
Ana Milena del Valle Trauma and Critical Care Surgery, Universidad del Valle. Cali, Colombia
Alberto F. García Fundacion Valle del Lili, Division of Trauma and Acute Care Surgery, Cali, Colombia
Alfonso Holguín Fundacion Valle del Lili, Radiology Department, Cali, Colombia
Abstract

Purpose: The objective of this study was to evaluate the implementation of a new Single-Pass WBCT Protocol in the management of patients with severe trauma.


Methods: This was an observational, prospective study of polytrauma patients who underwent WBCT. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, WBCT parameters and outcome variables were evaluated.


Results: 263 patients were included. Median Injury Severity Score (ISS) was 22 (IQR: 16-22). Time between arrival to the ED and completing the WBCT was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50); p=0.96]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. RSR 85% (p=0.69); Group 2: TRISS 69% vs. RSR 74% (p=0.25); Group 3: TRISS 93% vs. RSR 87% (p=0.07)].


Conclusion: This new Single-Pass WBCT Protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

Keywords
  • Blunt and Penetrating Trauma
  • Hemodynamic instability
  • Whole-Body Computed Tomography
  • Injury Severity Score
  • Wounds, Nonpenetrating
  • Abdominal Injuries
  • Emergency Service
  • Decision Making
  • Tomography, X-Ray Computed* / mortality
  • Tomography, X-Ray Computed* / statistics & numerical data
  • Whole Body Imaging* / mortality
  • Whole Body Imaging* / statistics & numerical data
  • Wounds, Nonpenetrating / diagnostic imaging
Author Biography

Carlos Ordoñez, Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali, Colombia

orcid_id45.png https://orcid.org/0000-0003-4495-7405

How to Cite
Ordoñez, C., García, C., Parra, M. W., Angamarca, E., Guzmán-Rodríguez, M., Orlas, C. P., Herrera-Escobar, J. P., Rincón, E., Meléndez, J. J., Serna, J. J., Padilla, N., del Valle, A. M., García, A. F., & Holguín, A. (2020). Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?. Colombia Medica, 51(1), e4224. https://doi.org/10.25100/cm.v51i1.4224
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Received 2020-02-21
Accepted 2020-06-18
Published 2020-03-02
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