Conditional unnecessity of head CT for whole-body CT of traffic accident victims: a pilot study
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ORIGINAL ARTICLE
Conditional unnecessity of head CT for whole-body CT of traffic accident victims: a pilot study Minako Azuma 1 Toshinori Hirai 1
&
Hiroshi Nakada 1 & Keiji Kitatani 1 & Norihiro Shinkawa 1 & Zaw Aung Khant 1 & Hidenobu Ochiai 2 &
Received: 10 July 2020 / Accepted: 4 September 2020 # American Society of Emergency Radiology 2020
Abstract Purpose To investigate whether head CT should be included in whole-body CT in road traffic accident victims. Methods A review of electronic medical records identified 124 patients (81 males, 43 females; age 4 to 92 years, mean 47.7 years) involved in a road traffic accident in a 12-month period. All had undergone whole-body CT and physical and neurologic examinations. We recorded their age, sex, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), the type of traffic accident, and the presence/absence of visible trauma above the clavicles (VTCs) and of acute traumatic brain injury (TBI) on CT. Statistical analyses were performed to evaluate predictors of acute TBI. Results Of 124 patients, 34 (27%) manifested acute TBI on CT. Univariate analysis identified their age, GCS, SBP, VTCs, and the accident type as statistically significant factors for acute TBI (p < 0.05). Multivariate analysis demonstrated VTCs, GCS score < 15, and SBP ≤ 90 mmHg were significant independent predictors of acute TBI (p = 0.001, p = 0.001, and p = 0.004, respectively); the odds ratio was 16.07 for VTCs, 14.85 for GCS score < 15, and 13.78 for SBP ≤ 90 mmHg. No patients without both decrease in GCS score and VTCs manifested acute TBI. Conclusion Our pilot study showed that visible trauma above the clavicles and decrease in GCS score were highly associated with the presence of acute TBI in road traffic accident victims. In whole-body CT, a head CT may not be indicated in patients without these factors. Keyword Head CT . Traumatic brain injury (TBI) . Whole-body CT . Traffic accident victims
Introduction Road traffic injuries are the leading cause of unintentional injuries, accounting for the greatest proportion of deaths from unintentional injuries [1]. They are the leading cause of injuryrelated disability-adjusted life years, and they pose a significant economic and societal burden [1]. For patients with trauma including road traffic injuries, whole-body CT scans including the head, chest, abdomen, pelvis, and spine with or Minako Azuma and Hiroshi Nakada contributed equally to this work. * Minako Azuma [email protected] 1
Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
2
Center for Emergency and Critical Care Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
without contrast administration can be performed in a singlepass or segmented acquisition [2]. Increasing numbers of trauma centers use immediate whole-body CT for the primary assessment of trauma patients. The high diagnostic accuracy of whole-body CT for a wide variety of traumatic injuries has been reported [3–5] as has its substantial time saving
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