Whole-Body CT is Safe, Effective and Efficient in the Severely Injured Hemodynamically Unstable Trauma Patient

Abstract

Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of Damage Control Trauma Care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience on the use of Whole Body Computed Tomography as a potentially safe, effective, and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status. Our general recommendation is that, when feasible, perform a Whole-Body Computed Tomography without interrupting ongoing hemostatic resuscitation in cases of severely injured trauma patients with or without signs of hemodynamic instability. The use of this technology will aid in the decision-making of the best surgical approach for these patients without incurring any delay in definitive management and/or increasing significantly their radiation exposure.

Authors

• Carlos Alberto Ordoñez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia. https://orcid.org/0000-0003-4495-7405
• Michael Parra Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA https://orcid.org/0000-0001-6496-6275
• Alfonso Holguín Department of Radiology. Fundación Valle del Lili, Colombia.
• Carlos Garcia Department of Radiology. Fundación Valle del Lili, Colombia.
• Monica Guzmán-Rodríguez Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile https://orcid.org/0000-0002-5515-263X
• Natalia Padilla Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0003-3292-6919
• Yaset Caicedo Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-6128-0128
• Claudia Patricia 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, USA https://orcid.org/0000-0002-2249-9960
• Alberto Garcia Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia https://orcid.org/0000-0002-4096-1434
• Fernando Rodríguez-Holguín Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia https://orcid.org/0000-0002-5326-2317
• Jose Julian Serna Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia