CT polytrauma/multitrauma, also called trauma CT, whole body CT (WBCT) or panscan, is an increasingly used investigation in patients with multiple injuries sustained after significant trauma.
The majority of the evidence regarding whole-body CT is, understandably, retrospective. There is some evidence from meta-analyzes that trauma patients who undergo WBCT have better survival than patients who undergo selective imaging 3,10 but this is yet to be definitely proven in randomized controlled trials 5,8,9.
Patients who undergo immediate WBCT at presentation have a similar radiation dose at discharge to patients who undergo a selective imaging strategy 9,10. As well as traumatic injuries, trauma CT uncovers incidental findings which have varying levels of significance 6,7.
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Indications
Indications will vary from institution-to-institution but indications by mechanism include:
- high speed motor vehicle collision
- non-trivial motorcycle collision
- death at the scene
- fall from height >2 meters
- other concerning mechanism of injury
- abnormal FAST, or trauma chest or pelvis x-ray
- abnormal vital signs
Purpose
Clinical assessment and mechanism of injury may underestimate injury severity by 30% 8. The purpose of the scan is first and foremost, the rapid evaluation of life threatening injuries and secondly the accurate diagnosis of known and unknown injuries.
Technique
Standard whole-body CT
The actual procedure will vary depending on institutional protocol/guidelines, but a typical protocol will consist of:
- non-contrast head
- non-contrast cervical spine
-
contrast-enhanced chest (arterial phase)
- scan extent to mid abdomen
- contrast enhanced abdomen (portal venous phase)
Additions to the whole-body CT protocol
Additionally, depending on the injuries present and especially if the images are reviewed with the patient on the CT table, the following phases may be useful:
- delayed phase of the abdomen/pelvis
- useful to assess for contrast pooling/contrast extravasation indicative of active bleeding
-
angiogram from the aortic arch to vertex
- used to asses penetrating neck injuries or risk factors for blunt cerebrovascular injuries
- angiogram of the head
- used to asses abnormalities of the circle of Willis
-
renal excretory phase of the abdomen/pelvis
- useful in patients with traumatic renal injuries (to assess for urinoma and upgrade AAST grading)
-
CT cystogram
- to assess for bladder injury
Variations to the whole-body CT protocol
- addition of a non-contrast chest and abdomen
- used in the context of suspected bleeds
- additional non-contrast CT of the upper abdomen
- CT angiogram of the abdomen/pelvis and lower limbs in the setting of suspected major hemorrhage and/or pelvic/lower limb fractures
- triphasic injection single pass CT of the chest, abdomen and pelvis 4
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