Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?

Shannon Marie Foster, Alison Muller, Jeremy Conklin, Vicente Cortes, Forrest B. Fernandez, Thomas A. Geng, Eugene F. Reilly, Adam Sigal, Adrian W. Ong

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients. Methods: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as “low index” or “more than a low index”. The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated. Results: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis). Conclusion: Clinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary. For awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.

Original languageEnglish (US)
Pages (from-to)755-759
Number of pages5
JournalAmerican Journal of Surgery
Volume218
Issue number4
DOIs
StatePublished - Oct 2019

All Science Journal Classification (ASJC) codes

  • Surgery

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