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Am J Surg. 2019 Oct;218(4):755-759. doi: 10.1016/j.amjsurg.2019.07.010. Epub 2019 Jul 17.

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

Author information

1
Reading Trauma Center, Reading Hospital, Tower Health System, United States. Electronic address: Shannon.foster@towerhealth.org.
2
Reading Trauma Center, Reading Hospital, Tower Health System, United States.

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.

SUMMARY:

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.

KEYWORDS:

Clinical judgement; Computed tomography; Intoxicated falls; Low energy trauma; Suspicion of injury

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