Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?
BACKGROUND: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients.
METHODS: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as "low index" or "more than a low index". The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated.
RESULTS: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis).
CONCLUSION: Clinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary.
SUMMARY: For awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.
Published In/Presented At
Foster, S. M., Muller, A., Conklin, J., Cortes, V., Fernandez, F. B., Geng, T. A., Jr, Reilly, E. F., Sigal, A., & Ong, A. W. (2019). Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?. American journal of surgery, 218(4), 755–759. https://doi.org/10.1016/j.amjsurg.2019.07.010
Medicine and Health Sciences
Department of Surgery