The Debate: The “panscan” should be standard of care for all major trauma patients.
For: Michael Hunter
Outline The "Pan-scan" should be the standard of care for all major trauma patients
Mike Hunter
NB
* Standard of care
- Degree of prudence and caution required of a person who is under a duty of care
* "major" trauma patients
What's a Pan-scan?
Usually means "whole body" CT
* Rapid
* Multislice
* Head/neck/trunk
Sometimes we need all the help we can get....and quickly
Major Trauma CT protocol
* C Smith et al. EMJ (BMJ.com) June 2010
* University Hospitals of Coventry and Warwickshire
Indications for Major trauma CT
* Penetrating trauma
* Gunshot wound (including air rifle)
* Blast injury (bomb / explosion)
* Blunt trauma
* Combined velocity > 50 km/h
* Motor vehicle crash with ejection
* Motorcyclist or pedestrian hit by vehicle >30 km/h
* Fall > 3 metres
* Fatality in the same vehicle
* Entrapment > 30 minutes
* Crush injury to thorax / abdomen
Results
* 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
* Munich
Routine Panscan in blunt trauma
* 1000 pts 592 no signs
* Results:
- 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
* Rapid
* Half the radiation dose of CT
* Focuses team on abdomen and head
Additional views
* Lateral C-spine
A word of warning about Parke....
|
Ministry of Health
