US FAST Scan Chest Abdomen Pelvis The role of FAST (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [9,10]. Extended-FAST has been found to be effective in ruling out pneumothorax [11]. Although ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, its relatively lower specificity compared with CT does not make it a sufficient test to exclude injuries to these areas [5]. FAST has been found to have a high false-negative rate in patients with pelvic fractures [12]. Radiography Trauma Series Trauma series radiographs in the unstable patient typically consist of portable radiographs of the chest and pelvis. A portable anteroposterior (AP) chest radiograph helps screen for immediately life-threatening findings, such as tension pneumothorax and significant mediastinal injury, as well as confirms line placement [13]. A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI in the initial evaluation of the unstable trauma patient. MRI is not performed because of the time required in the emergent setting. Variant 2: Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging. CT Whole Body Currently, there is no practice consensus or validated decision rules for deciding which patients should receive WBCT versus selective CT imaging for blunt trauma. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no survival benefit [15]. Meta-analyses have yielded conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain WBCT versus selective CT.
Major Blunt Trauma. US FAST Scan Chest Abdomen Pelvis The role of FAST (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [9,10]. Extended-FAST has been found to be effective in ruling out pneumothorax [11]. Although ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, its relatively lower specificity compared with CT does not make it a sufficient test to exclude injuries to these areas [5]. FAST has been found to have a high false-negative rate in patients with pelvic fractures [12]. Radiography Trauma Series Trauma series radiographs in the unstable patient typically consist of portable radiographs of the chest and pelvis. A portable anteroposterior (AP) chest radiograph helps screen for immediately life-threatening findings, such as tension pneumothorax and significant mediastinal injury, as well as confirms line placement [13]. A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI in the initial evaluation of the unstable trauma patient. MRI is not performed because of the time required in the emergent setting. Variant 2: Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging. CT Whole Body Currently, there is no practice consensus or validated decision rules for deciding which patients should receive WBCT versus selective CT imaging for blunt trauma. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no survival benefit [15]. Meta-analyses have yielded conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain WBCT versus selective CT.