Initial imaging. The body regions covered in this clinical scenario are the upper extremity and lower extremity. 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, and extremity injuries alone will not determine which is Major Blunt Trauma appropriate. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. 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]. CT Extremity In certain cases, CT may be appropriate for fracture characterization, detection of radiographically occult fractures, or operative planning. CTA Extremity CT angiography (CTA) of an upper or lower extremity injury may also be considered and could be obtained during the same acquisition period to evaluate for extremity arterial injury when clinically suspected [24].
Major Blunt Trauma. Initial imaging. The body regions covered in this clinical scenario are the upper extremity and lower extremity. 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, and extremity injuries alone will not determine which is Major Blunt Trauma appropriate. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. 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]. CT Extremity In certain cases, CT may be appropriate for fracture characterization, detection of radiographically occult fractures, or operative planning. CTA Extremity CT angiography (CTA) of an upper or lower extremity injury may also be considered and could be obtained during the same acquisition period to evaluate for extremity arterial injury when clinically suspected [24].