uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Show others and affiliations
2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 6, p. 750-757Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2016. Vol. 57, no 6, p. 750-757
Keywords [en]
CT; adults; trauma; radiation safety; equipment; contrast agents - intravenous
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-282885DOI: 10.1177/0284185115597718ISI: 000375726300018PubMedID: 26271124OAI: oai:DiVA.org:uu-282885DiVA, id: diva2:917710
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2018-02-14Bibliographically approved
In thesis
1. Trauma - Diagnostics and Triage
Open this publication in new window or tab >>Trauma - Diagnostics and Triage
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
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.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1431
Keywords
wounds and injuries, trauma, triage, whole body computed tomography in trauma, compliance, radiation exposure, CT, radiation safety
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-341763 (URN)978-91-513-0242-3 (ISBN)
Public defence
2018-04-13, Enghoffsalen, ingång 50bv, Akademiska sjukhuset, 751 85, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-23 Created: 2018-02-14 Last updated: 2018-04-24

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Linder, FredrikEklöf, Hampus

Search in DiVA

By author/editor
Linder, FredrikEklöf, Hampus
By organisation
Department of Medical SciencesColorectal SurgeryRadiology
In the same journal
Acta Radiologica
Radiology, Nuclear Medicine and Medical Imaging

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 503 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf