Indications that may warrant WBCT imaging as defined above, include high-velocity (>35 mph) motor vehicle collision (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]. MRI Abdomen and Pelvis There is no relevant literature to support the initial use of MRI in patients who are hemodynamically stable, not otherwise specified. 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. Although 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 fully exclude injuries to these areas [5]. Major Blunt Trauma Fluoroscopy Retrograde Urethrography There is no relevant literature to support the use of retrograde urethrography in patients with major blunt trauma who are hemodynamically stable, not otherwise specified. Refer to Variant 6 if there is suspicion of urinary tract injury. CT Whole Body The decision regarding which patients should receive WBCT versus selective CT imaging for blunt trauma will depend on factors beyond facial injury.
Major Blunt Trauma. Indications that may warrant WBCT imaging as defined above, include high-velocity (>35 mph) motor vehicle collision (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]. MRI Abdomen and Pelvis There is no relevant literature to support the initial use of MRI in patients who are hemodynamically stable, not otherwise specified. 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. Although 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 fully exclude injuries to these areas [5]. Major Blunt Trauma Fluoroscopy Retrograde Urethrography There is no relevant literature to support the use of retrograde urethrography in patients with major blunt trauma who are hemodynamically stable, not otherwise specified. Refer to Variant 6 if there is suspicion of urinary tract injury. CT Whole Body The decision regarding which patients should receive WBCT versus selective CT imaging for blunt trauma will depend on factors beyond facial injury.