Modern capabilities and methodological features of computed tomography of the whole body in the study of victims with polytrauma

The gold standard for diagnosing injuries in polytrauma is computed tomography (CT) of the whole body. This method of radiation diagnostics allows to quickly and non-invasively obtain high-resolution images for an accurate assessment of all trauma-related injuries.

To date, there are different opinions on the optimal algorithm for conducting and evaluating CT in patients with polytrauma, but a unified standard of research methods for this category of patients has not been developed.

This article presents the experience of various domestic and foreign hospitals providing medical care to patients with various types of combined and multiple injuries, as well as describes methodological recommendations for performing and analyzing CT of the whole body in patients with polytrauma, obtained on the basis of our own practical experience. In the article, we also reflected the peculiarities of the interpretation of the resulting traumatic injuries in the native, arterial, venous and delayed phases of scanning; clinical examples of CT studies in patients with polytrauma are given. We noted the particular importance of postprocessing processing of images obtained during CT examination. Here, we recommend performing CT of the whole body in polytrauma with the use of multiphase intravenous bolus contrasting, which allows a more detailed assessment of the changes in internal organs and soft tissues and diagnoses the presence and nature of bleeding. Comprehensive and detailed evaluation of CT images obtained in patients with polytrauma is aimed at helping clinical specialists choose the best treatment method, prioritizing and predicting patient management in each case.

1. The world health report 2001. Mental health: new understanding, new hope. Geneva: World Health Organization; 2001.

2. Von Ruden C, Woltmann A, Rose M, et al. Outcome after severe multiple trauma: a retrospective analysis. J Trauma Manag Outcomes. 2013; 7(1): 4.

3. Dubrov VE, Blazhenko AN, Khanin MY, et al. Realization of damage control concept in acute period of polytrauma. Politravma=Polytrauma. 2012; 2: 68-73. In Russian

4. Boyko IV, Zaft VB, Lazarenko GO. Organization of emergency medical care for patients with polytrauma at the stages of medical evacuation. Meditsina neotlozhnykh sostoyaniy=Emergency medicine. 2013; 2(49): 77-84. In Russian

5. Bagnenko SF, Minullin IP, Chikin AE, et al. Better medical aid to road accident casualties. Vestnik Roszdravnadzora= Roszdravnadzor Bulletin. 2013; 5: 2530. In Russian

6. Foster bR, Anderson SW, Uyeda JW, et al. Integration of 64-detector lower extremity CT angiography into whole-body trauma imaging: feasibility and early experience. Radiology. 2011; 261(3): 787-795.

7. Monazzam S, Goodell PB, Salcedo ES, et al. When are CT angiograms indicated for patients with lower extremity fractures? A review of 275 extremities. J Trauma Acute Care Surg. 2017; 82(1): 133-137.

8. Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016; 121(5): 409-430.

9. Gunn ML, Kool DR, Lehnert BE. Improving outcomes in the patient with polytrauma: a review of the role of whole-body computed tomography. Radiol Clin North Am. 2015; 53(4): 639-656.

10. Eichler K, Marzi I, Wyen H, et al. Multidetector computed tomography (MDCT): simple CT protocol for trauma patient. Clin Imaging. 2015; 39(1): 110-115.

11. Pinto F, Valentino M, Romanini L, et al. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med. 2015; 120(1): 3-11.

12. Shojaee M, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chin J Traumatol. 2014; 17 (1): 19-24.

13. Gupta M, Schriger DL, Hiatt JR, et al. Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma. Ann Emerg Med. 2011; 58(5): 407-416.

14. Stengel D, Ottersbach C, Matthes G, et al. Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma. CMAJ. 2012; 184(8): 869-876.

15. Vu M, Anderson SW, Shah N, et al. CT of blunt abdominal and pelvic vascular injury. Emerg Radiol. 2010; 17(1): 21-29.

16. Uyeda JW, Anderson SW, Sakai O, et al. CT angiography in trauma. Radiol Clin North Am. 2010; 48(2): 423-438.

17. Anderson SW, Varghese JC, Lucey BC, et al. Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology. 2007; 243(1): 88-95.

18. Sierink Jc, Saltzherr TP, Reitsma JB, et al. Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients. Br J Surg. 2012; 99 Suppl 1: 52-58.

19. Stengel D, Ottersbach C, Matthes G, et al. Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma. CMAJ. 2012; 184(8): 869-876.

20. Ierardi AM, Piacentino F, Fontana F, et al. The role of endovascular treatment of pelvic fracture bleeding in emergency settings. Eur Radiol. 2015; 25(7): 1854-1864.

21. Miele V, Di Giampietro I. Diagnostic imaging in emergency. Salute Soc. 2014; 2: 127-138.

22. Rincon S, Gupta R, Ptak T. Imaging of head trauma. Handb Clin Neurol. 2016; 135: 447-477.

23. Gareev IF, Beylerli OA, Vizgalova AE. Full-body CT scan in polytrauma diagnosis. Analysis of ten years’ experience. Kreativnaya hirurgiya i onkologiya=Creative surgery and oncology. 2019; 9(4): 273-277. In Russian

24. Akhadov TA, Karaseva OV, Chernyshova TA, et al. Radiation diagnosis of abdominal trauma in children. Detskaya Khirurgya=Pediatric surgery. 2018; 22(1): 21-28. In Russian