The most common injury misses were the ones to the sacrum, sacroiliac joints, and loose bodies in the hip joints. MRI Chest There is no relevant literature to support the use of MRI for the initial evaluation of blunt chest trauma. It is not routinely performed because of the time required in the emergent setting. Use of MRI is mainly reserved for problem solving of findings identified on initial imaging studies. Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging. CT Abdomen and Pelvis For blunt trauma in a pregnant woman, CT of the abdomen and pelvis with IV contrast may still be recommended when there is a life-threatening concern for the mother or fetus. The study is typically performed in the portal venous phase, 70 seconds after contrast administration, for ideal characterization of solid organ injury. This may be obtained in conjunction with CTA as well as delayed imaging of the abdomen and pelvis. The administration of oral contrast material has not been found to alter the sensitivity or specificity for blunt abdominal injuries and is not recommended because it can delay definitive diagnosis of other injuries [25]. Noncontrast CT of the abdomen and pelvis should ideally be avoided because of its lower sensitivity for detecting both visceral organ and vascular injuries [19]. CT Whole Body Risks and benefits must be specifically weighed regarding CT imaging of the pregnant patient. No practice consensus or validated decision rules currently exist for deciding which patients should receive WBCT versus selective CT imaging for blunt trauma. Some studies in nonpregnant patients 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.
Major Blunt Trauma. The most common injury misses were the ones to the sacrum, sacroiliac joints, and loose bodies in the hip joints. MRI Chest There is no relevant literature to support the use of MRI for the initial evaluation of blunt chest trauma. It is not routinely performed because of the time required in the emergent setting. Use of MRI is mainly reserved for problem solving of findings identified on initial imaging studies. Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging. CT Abdomen and Pelvis For blunt trauma in a pregnant woman, CT of the abdomen and pelvis with IV contrast may still be recommended when there is a life-threatening concern for the mother or fetus. The study is typically performed in the portal venous phase, 70 seconds after contrast administration, for ideal characterization of solid organ injury. This may be obtained in conjunction with CTA as well as delayed imaging of the abdomen and pelvis. The administration of oral contrast material has not been found to alter the sensitivity or specificity for blunt abdominal injuries and is not recommended because it can delay definitive diagnosis of other injuries [25]. Noncontrast CT of the abdomen and pelvis should ideally be avoided because of its lower sensitivity for detecting both visceral organ and vascular injuries [19]. CT Whole Body Risks and benefits must be specifically weighed regarding CT imaging of the pregnant patient. No practice consensus or validated decision rules currently exist for deciding which patients should receive WBCT versus selective CT imaging for blunt trauma. Some studies in nonpregnant patients 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.