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The Debate: The “panscan” should be standard of care for all major trauma patients.
* 87 of 114 eligible patients received a Major Trauma CT
* 17 unsuspected injuries were found
* 3 needed immediate management
Reduced time to OR
- 105 vs 120 mins
* Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma
* T E Wurmb et al EMJ. Online July 2010
* University Hospital of Wuerzburg
Reduction in mortality risk
* German hospitals contributing to registry of German Trauma Society
* 1494 of 4261 (32%) given whole body CT
* SMR based on TRISS was 0.745 (95% CI 0.633-0.859) for patients given whole-body CT versus 1.023 (0.909-1.137) for those given non-whole-body CT (p<0.001).
* Huber-Wagner et al. Lancet April 2009
Routine Panscan in blunt trauma
* 1000 pts 592 no signs
- Clinically significant abnormalities were found in
* 3.5% of head CT scans,
* 5.1% of cervical spine CT scans,
* 19.6% of chest CT scans, and
* 7.1% of abdominal CT scans.
* Overall treatment was changed in 18.9% of patients based on abnormal CT scan findings.
- Salim et al. Arch Surg 2006
What about the radiation?
* Dispute over dose
- 12-16 mSv
- Some claims up to 140 mSv
- Increase in background lifetime risk of fatal cancer from 25% to 25.05%
- Significantly less in a pan-scan than in sequential scans of body regions
Alternative to CT
* Lodox STATSCAN
* Half the radiation dose of CT
* Focuses team on abdomen and head
* Lateral C-spine
A word of warning about Parke....