CT of the chest, abdomen, and pelvis with IV contrast have 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 of the abdomen and pelvis may be performed to assess for active arterial bleeding. CTA of the abdomen has been shown to detect splenic vascular injuries more often than CT of the abdomen in the portal venous phase alone [26]. However, arterial phase imaging without 3-D reformations can also detect bleeding. 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]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI of the abdomen and pelvis in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. MR Urography There is no relevant literature to support the use of MRU in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. US Abdomen and Pelvis Although US may be able to diagnose certain abdominal injuries, its relatively lower sensitivity compared with CT does not make it a sufficient test to exclude abdominal injuries [29,41,42]. Extraperitoneal and genitourinary injuries are more likely to be missed than intraperitoneal injuries [41,42]. US FAST Scan Chest Abdomen Pelvis The role of FAST is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT.
Major Blunt Trauma. CT of the chest, abdomen, and pelvis with IV contrast have 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 of the abdomen and pelvis may be performed to assess for active arterial bleeding. CTA of the abdomen has been shown to detect splenic vascular injuries more often than CT of the abdomen in the portal venous phase alone [26]. However, arterial phase imaging without 3-D reformations can also detect bleeding. 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]. MRI Abdomen and Pelvis There is no relevant literature to support the use of MRI of the abdomen and pelvis in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. MR Urography There is no relevant literature to support the use of MRU in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. US Abdomen and Pelvis Although US may be able to diagnose certain abdominal injuries, its relatively lower sensitivity compared with CT does not make it a sufficient test to exclude abdominal injuries [29,41,42]. Extraperitoneal and genitourinary injuries are more likely to be missed than intraperitoneal injuries [41,42]. US FAST Scan Chest Abdomen Pelvis The role of FAST is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT.