Trauma

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Author: Mikael Häggström [notes 1]

Sudden physical injury:

Choice of modality

Severe trauma

Head

CT of the head in trauma, without IV contrast, is the first choice of investigation.

Neck (cervical spine)

In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, but when indicated, recommendations differ somewhat between children and adults:

  • In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US[3] and UK[4] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[5] It is thus reasonable to indicate CT by a combination of higher severity and older age.
  • In adults, UK guidelines are largely similar as in children.[4] US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.[6]

Chest

In blunt chest trauma, US guidelines mainly recommend the following two as complementary examinations:[7]

Abdomen and pelvis

According to US guidelines:[8]

Lumbar spine

  • Suspicion of a vertebral compression fracture alone, such as in an elderly patient with typical symptoms.
  • Low clinical suspicion of a fracture, according to US guidelines,[9] but low dose CT is still arguably superior if the local department has a low dose protocol (with up to only slightly larger radiation dose than X-ray).[10]
  • In children, according to Australian guidelines,[11] but again, low dose CT is arguably superior if there is a local low dose protocol.[10]

Extremities

X-ray of fractures is generally the initial choice.

Major targets

By modality

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. 1.0 1.1 Artigas Martín, J.M.; Martí de Gracia, M.; Claraco Vega, L.M.; Parrilla Herranz, P. (2015). "Radiology and imaging techniques in severe trauma ". Medicina Intensiva (English Edition) 39 (1): 49–59. doi:10.1016/j.medine.2014.06.003. ISSN 21735727. 
  2. Helén Milde, John Brandberg (2018-12-19). DTs Multitrauma rutiner. Sahlgrenska University Hospital, Gothenburg.
  3. Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
  4. 4.0 4.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
  5. . Traumamanual. Region Skåne. Last updated: 2018-03-29}}
  6. Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
  7. . Blunt Chest Trauma, ACR Appropriateness Criteria. American College of Radiology. Date of origin: 2013
  8. . Blunt Abdominal Trauma, ACR Appropriateness Criteria. American College of Radiology. Last review date: 2012
  9. USA:. ACR Appropriateness Criteria. American College of Radiology. Last review date: 2012
  10. 10.0 10.1 Alshamari, Muhammed; Geijer, Mats; Norrman, Eva; Lidén, Mats; Krauss, Wolfgang; Wilamowski, Franciszek; Geijer, Håkan (2015). "Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice ". Acta Radiologica 57 (5): 602–611. doi:10.1177/0284185115595667. ISSN 0284-1851. 
  11. 11.0 11.1 Australia:. Radiology - Acute indications. The Royal Children's Hospital Melbourne. Retrieved on 2018-12-14.