Contrast-enhanced computed tomography in polytrauma patients: Which predictors matter?

Introduction Contrast-enhanced computed tomography (ceCT) is widely used in the evaluation and management of polytrauma patients. Although guidelines exist on when ceCT is indicated, clinical practice, often in the hectic setting of the trauma bay, shows inconsistent use of this diagnostic modality. Keeping into account the potential harmful side effects of ceCT, the aim of this study was to investigate predictors that may allow more accurate application of ceCT in the polytrauma patient.

Materials & methods Patients with an ISS ≥ 16 who were admitted through the trauma bay of the level 1 trauma centre of RWTH Aachen University Hospital between 2010 and 2017 were included in this study. The following parameters were obtained: patient demographics, mechanism of injury, trauma severity, vital parameters, blood work, medical imaging results, length of stay (both in hospital and in the intensive care unit), and mortality.

Results A total of 651 polytrauma patients were included in this study. In 73% (n=478), a ceCT was performed in the trauma bay. Of these 478 patients, 23% had clinically relevant abnormalities in the ceCT, such as active bleeding or vessel dissection/occlusion, while 77% did not. Specific clinical parameters, such as concomitant thoracic trauma, penetrating trauma, falls from great heights (>3m), or lower extremity fractures, were found to have significant predictive power in relation to clinically relevant findings in ceCT"s.

Conclusion This study is among the first in its scale to quantify the unmet need for better predictive indicators in guiding the use of ceCT in the trauma bay. Specific patient characteristics and trauma mechanisms were shown to be strong predictors for clinically relevant findings in ceCT, and may help guide decision-making in the trauma bay, thereby reducing radiation exposure to our patients.

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