CT Whole Body Currently, there is no consensus for deciding which patients should receive WBCT versus selective CT imaging of the abdomen and pelvis for blunt trauma with concern for bowel injury. 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 Major Blunt Trauma 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 CT in the arterial phase may be carried through the abdomen and pelvis to assess for active arterial bleeding to abdominopelvic viscera and soft tissues. If 3-D reconstructions are included, then it is considered a CTA study to more closely evaluate the arterial structures for findings such as pseudoaneurysm. CTA of the abdomen has been shown to detect more splenic vascular injuries than that of CT of the abdomen in the portal venous phase alone [26].
Major Blunt Trauma. CT Whole Body Currently, there is no consensus for deciding which patients should receive WBCT versus selective CT imaging of the abdomen and pelvis for blunt trauma with concern for bowel injury. 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 Major Blunt Trauma 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 CT in the arterial phase may be carried through the abdomen and pelvis to assess for active arterial bleeding to abdominopelvic viscera and soft tissues. If 3-D reconstructions are included, then it is considered a CTA study to more closely evaluate the arterial structures for findings such as pseudoaneurysm. CTA of the abdomen has been shown to detect more splenic vascular injuries than that of CT of the abdomen in the portal venous phase alone [26].