Update Polytrauma und Computertomographie unter Reanimationsbedingungen

Gäble, Alexander; Hebebrand, Julian; Armbruster, Marco; Mück, Fabian; Berndt, Maria; Kumle, Bernhard; Fink, Ulrich und Wirth, Stefan (2020): Update Polytrauma und Computertomographie unter Reanimationsbedingungen. In: Radiologe, Bd. 60, Nr. 3: S. 247-257

Abstract

Clinical issue The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated. Standard radiological methods Considering severely injured patients with an Injury Severity Score (ISS) >= 16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment. Methodological innovation and evaluation In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible. Practical recommendations In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0033-832X
• Sprache: Deutsch