CT polytrauma (approach)

Below is an approach used for the "primary survey" of a CT polytrauma/multitrauma (also called trauma CT or whole body CT), often performed at the CT console with the patient still on the CT table. It allows rapid communication of significant findings to the trauma team as well as the decision to perform additional phases (e.g. delayed abdomen scanning).

CT polytrauma typically occurs after the primary survey and in a stable patient . There is evidence that polytrauma CT is suitable for unstable patients , however, policies of scanning these patients will differ based on institutional policy.

Approach

The radiologist will typically use a top-to-bottom approach as the brain and cervical spine are usually scanned first without intravenous contrast followed by assessment of the thorax, abdomen and pelvis with the focus on detecting the conditions with the highest mortality in trauma namely: traumatic brain injury and/or intrathoracic/intra-abdominal hemorrhage .

CT brain and cervical spine

• brain: bleeding, evidence of increased intracranial pressure, skull fractures
• detection of cervical spine fractures or malalignment suggestive of an unstable injury

CT thorax, abdomen and pelvis

Contrast-enhanced CT is commonly performed in trauma patients, with a large number of different protocols that vary depending on the institution.

• thorax
  • traumatic aortic injury, mediastinal hematoma, active bleeding
  • hemothorax/pneumothorax
  • major thoracic cage fractures
• abdomen/pelvis
  • free fluid (e.g. hemoperitoneum)
  • pneumoperitoneum
  • solid organ injury, in particular, liver, spleen, kidneys
  • active bleeding
  • unstable pelvic fractures
• thoracolumbar spine
  • fractures or malalignment suggestive of unstable discoligamentous injury

After the severe injuries that require immediate attention are detected or ruled out, the radiologist will conduct a more thorough search and evaluation of the polytrauma CT.