Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST. CT of the chest, abdomen, and pelvis with IV contrast has greater sensitivity for detecting visceral organ and vascular injury compared with noncontrast CT, and contrast-enhanced CT of these areas should be primarily considered unless absolutely contraindicated [19,20]. Patients who have an abnormal chest radiograph in the setting of trauma have clinically significant rates of major injury on CT chest [8]. CTA Abdomen and Pelvis CTA may be carried through the abdomen and pelvis to assess for active arterial bleeding to abdominopelvic viscera and soft tissues. CTA of the abdomen has been shown to detect more splenic vascular injuries than CT of the abdomen in the portal venous phase alone [26]. Unstable pelvic fractures, such as vertical shear and AP compression injury, are associated with higher rates of active hemorrhage and may require either surgical or vascular interventional treatment [27]. Major Blunt Trauma CTA Chest CTA of the chest is warranted in the arterial phase primarily to assess for aortic or other major vessel injury, in addition to other injuries within the chest [20]. Noncontrast CT of the chest should be avoided because of its lower sensitivity for detecting vascular injuries [20]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI abdomen and pelvis in patients who are hemodynamically stable and pregnant.
Major Blunt Trauma. Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST. CT of the chest, abdomen, and pelvis with IV contrast has greater sensitivity for detecting visceral organ and vascular injury compared with noncontrast CT, and contrast-enhanced CT of these areas should be primarily considered unless absolutely contraindicated [19,20]. Patients who have an abnormal chest radiograph in the setting of trauma have clinically significant rates of major injury on CT chest [8]. CTA Abdomen and Pelvis CTA may be carried through the abdomen and pelvis to assess for active arterial bleeding to abdominopelvic viscera and soft tissues. CTA of the abdomen has been shown to detect more splenic vascular injuries than CT of the abdomen in the portal venous phase alone [26]. Unstable pelvic fractures, such as vertical shear and AP compression injury, are associated with higher rates of active hemorrhage and may require either surgical or vascular interventional treatment [27]. Major Blunt Trauma CTA Chest CTA of the chest is warranted in the arterial phase primarily to assess for aortic or other major vessel injury, in addition to other injuries within the chest [20]. Noncontrast CT of the chest should be avoided because of its lower sensitivity for detecting vascular injuries [20]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI abdomen and pelvis in patients who are hemodynamically stable and pregnant.