CT polytrauma (technique)

Dr Henry Knipe and Dr Jeremy Jones et al.

CT polytrauma/multitrauma, also called trauma CTwhole body CT (WBCT) or panscan, is an increasingly used investigation in patients with multiple injuries sustained after significant trauma.

Clinical assessment and mechanism of injury may underestimate injury severity by 30% 8. There is some evidence from meta-analyses 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 randomised controlled trials 5,8,9. Patients who undergo immediate WBCT at presentation have a similar radiation dose at discharge as 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.

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 metres
  • other concerning mechanism of injury
  • abnormal FAST, or trauma chest or pelvis x-ray
  • abnormal vital signs

Technique

The actual procedure will vary depending on institutional protocol/guidelines, but a typical protocol will include non-contrast and contrast-enhanced CT of the head, neck, chest, and abdomen/pelvis (i.e. panscan/WBCT):

Additionally depending on the injuries present, especially if the images are reviewed with the patient is still on the CT table, the following phases may be useful:

There are numerous variations including:

  • additional non-contrast CT of the upper abdomen
  • CT angiogram of the abdomen/pelvis and lower limbs in the setting of suspected major haemorrhage and/or pelvic/lower limb fractures
  • triphasic injection single pass CT of the chest, abdomen and pelvis 4
CT examinations
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Article information

rID: 9051
Section: Radiography
Synonyms or Alternate Spellings:
  • CT of multi-trauma
  • CT multitrauma
  • CT multi-trauma
  • Trauma panscan
  • Whole body CT (WBCT)

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    Case 4: renal excretory phase
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    Case 5: thoracic CT angiogram
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