Trauma - Diagnostics and Triage

Trauma is a leading cause of death worldwide and it reduces years of productive life and leads to disability. Effective trauma care relies on triage, which aims to ration the use of fine resources to patients with the greatest needs. Imaging is essential in the severely injured patient, but comes at a cost of radiation exposure, which could cause cancer in up to 1/1000 patients examined with whole body computed tomography. Paper I showed that routine whole-body CT of high-energy trauma patients may lead to excessive radiation exposure without clinical benefit. There were no missed injuries in the low risk group and the mean injury severity score (ISS) was 0.84 in this group (standard deviation SD 1.57). Paper II surveyed radiologists at 93 Nordic and 10 non-Nordic hospitals with 23 questions on usage of whole body CT in trauma. The response rate was 62% and there were several differences in criteria, protocols and radiation dose. Most, 89% consider there is a need for national/international guidelines. Paper III evaluated compliance with trauma alert criteria with the aim to describe how resources may be optimized with sustained low undertriage. The compliance with full trauma alert and no trauma alert was 80% and 79% respectively. Compliance with limited trauma alert was only 54%, and prehospital immobilization was an independent risk factor for mistriage with an odds ratio of 1.78 (95% CI 1.42 - 2.23). Paper IV demonstrated that the newly implemented Swedish trauma team activation (TTA) criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety. In conclusion, whole body CT in trauma should be used only in patients with clinical findings. The routines for use of whole body CT in trauma differ between institutions, and efforts to establish common guidelines are requested. Better compliance with alert criteria may optimize resource allocation, and the newly implemented national TTA criteria in Sweden are safe and resource efficient.