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Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
Vise andre og tillknytning
2016 (engelsk)Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, nr 6, s. 750-757Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Whole body computed tomography in trauma (WBCTT) is a standardized CT examination of trauma patients. It has a relatively high radiation dose. Therefore, well-defined clinical indications and imaging protocols are needed. This information regarding Nordic countries is limited.

PURPOSE: To identify Nordic countries' WBCTT imaging protocols, radiation dose, and integration in trauma care, and to inquire about the need for common Nordic guidelines.

MATERIAL AND METHODS: A survey with 23 multiple choice questions or free text responses was sent to 95 hospitals and 10 trauma centers in and outside the Nordic region, respectively. The questions were defined and the hospitals selected in collaboration with board members of "Nordic Forum for Trauma and Emergency Radiology" (www.nordictraumarad.com).

RESULTS: Two Nordic hospitals declined to take part in the survey. Out of the remaining 93 Nordic hospitals, 56 completed the questionnaire. Arterial visualization is routine in major trauma centers but only in 50% of the Nordic hospitals. The CT scanner is located within 50 m of the emergency department in all non-Nordic trauma centers but only in 60% of Nordic hospitals. Radiation dose for WBCTT is in the range of 900-3600 mGy × cm. Of the 56 responding Nordic hospitals, 84% have official guidelines for WBCTT. Eighty-nine percent of the responders state there is a need for common guidelines.

CONCLUSION: Scanning protocols, radiation doses, and routines differ significantly between hospitals and trauma centers. Guideline for WBCTT is presently defined locally in most Nordic hospitals. There is an interest in most Nordic hospitals to endorse new and common guidelines for WBCTT.

sted, utgiver, år, opplag, sider
2016. Vol. 57, nr 6, s. 750-757
Emneord [en]
CT; adults; trauma; radiation safety; equipment; contrast agents - intravenous
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-282885DOI: 10.1177/0284185115597718ISI: 000375726300018PubMedID: 26271124OAI: oai:DiVA.org:uu-282885DiVA, id: diva2:917710
Tilgjengelig fra: 2016-04-07 Laget: 2016-04-07 Sist oppdatert: 2018-02-14bibliografisk kontrollert
Inngår i avhandling
1. Trauma - Diagnostics and Triage
Åpne denne publikasjonen i ny fane eller vindu >>Trauma - Diagnostics and Triage
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Trauma is a leading cause of death worldwide and it reduces years of productive life and leads to disability. Effective trauma care relies on triage, which aims to ration the use of fine resources to patients with the greatest needs. Imaging is essential in the severely injured patient, but comes at a cost of radiation exposure, which could cause cancer in up to 1/1000 patients examined with whole body computed tomography.

Paper I showed that routine whole-body CT of high-energy trauma patients may lead to excessive radiation exposure without clinical benefit. There were no missed injuries in the low risk group and the mean injury severity score (ISS) was 0.84 in this group (standard deviation SD 1.57). Paper II surveyed radiologists at 93 Nordic and 10 non-Nordic hospitals with 23 questions on usage of whole body CT in trauma. The response rate was 62% and there were several differences in criteria, protocols and radiation dose. Most, 89% consider there is a need for national/international guidelines. Paper III evaluated compliance with trauma alert criteria with the aim to describe how resources may be optimized with sustained low undertriage. The compliance with full trauma alert and no trauma alert was 80% and 79% respectively. Compliance with limited trauma alert was only 54%, and prehospital immobilization was an independent risk factor for mistriage with an odds ratio of 1.78 (95% CI 1.42 - 2.23). Paper IV demonstrated that the newly implemented Swedish trauma team activation (TTA) criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety.

In conclusion, whole body CT in trauma should be used only in patients with clinical findings. The routines for use of whole body CT in trauma differ between institutions, and efforts to establish common guidelines are requested. Better compliance with alert criteria may optimize resource allocation, and the newly implemented national TTA criteria in Sweden are safe and resource efficient.  

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 75
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1431
Emneord
wounds and injuries, trauma, triage, whole body computed tomography in trauma, compliance, radiation exposure, CT, radiation safety
HSV kategori
Forskningsprogram
Kirurgi
Identifikatorer
urn:nbn:se:uu:diva-341763 (URN)978-91-513-0242-3 (ISBN)
Disputas
2018-04-13, Enghoffsalen, ingång 50bv, Akademiska sjukhuset, 751 85, Uppsala, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2018-03-23 Laget: 2018-02-14 Sist oppdatert: 2018-04-24

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