Table 4.

Indications for selective CT scanning after conventional imaging

CT-brain A patient with trauma of the head and with at least: → 1 major criterion: - EMV ≤13 - loss of consciousness >30 min - haemodynamically unstable - age ≥60 years - high-risk trauma - vomiting - posttraumatic seizure - coagulopathy risk factors (primary or by medication) - focal neurological deficit - >1 point decline in EMV after 1 h - posttraumatic amnesia >4 h - clinical suspicion for skull base or facial fractures → and/or at least 2 minor criteria: - age between 40-60 years - posttraumatic loss of consciousness - posttraumatic amnesia 2-4 h - externally facial injuries without signs of fractures - 1-point decline in EMV after 1 h CT of the cervical spine 1. Always when CT-brain is performed 2. In all patients unless they meet all the Nexus criteria: - no posterior midline cervical spine tenderness - no focal neurological deficit - a normal level of alertness - no evidence of intoxication - no painful distracting injuries X-cervical spine Never indicated. If Nexus deviant: cervical-CT. Chest CT (with iv contrast) 1. Chest gunshot wound with suspicion of transmediastinal route 2. Acute aortic injury 3. Abnormal mediastinum seen at chest radiography. - mediastinal widening - pleural cap (‘apical cap’) - aorta arc unclear enclosed - left main bronchus removed downwards - deviated trachea or oesophagus - filled aortopulmonary window - widened paraspinal line - widened paratracheal line right 3. Relative indications: - type and severity of trauma - fractures of costa 1 or 2 - thoracic spine fracture - posterior sternoclavicular luxation - hesitation about the existence of pneumothorax/pneumomediastinum or pneumopericardium - fractures of the clavicle and shoulder

Abdominal CT (with iv contrast) 1. Penetrating injuries in abdomen, chest and/or flank 2. Deficits found with FAST - intra-abdominal free fluid - suspicion organ injury - suspicion retroperitoneal injury 3. Dislocated pelvic ring fracture and/or dislocated acetabulum fracture 4. Clinical suspicion of intraabdominal injury at physical examination 5. Subjective judgment of severity of injury by trauma leader - combined thoracic and pelvic injury - ‘seatbelt sign’ - chance fracture X-thoracic and lumbar spine Not indicated when chest or abdominal CT is performed (reconstructions can be made) 1. Complaints of the thoracic and lumbar spine 2. Tenderness of the thoracic and lumbar spine in the midline 3. Loss of consciousness 4. Deficits in peripheral neurologic examination 5. Painful distracting injuries Pelvic CT (with iv contrast) 1. All pelvic ring and acetabulum fractures unless conventional imaging is sufficient for adequate diagnosis and treatment 2. After reposition of hip luxation with suspicion of femoral head fractures and/or acetabulum fracture. When CT-abdomen is performed, CT-pelvis is not necessary. Retrograde urethrogram 1. Male patient with severe pelvic injury (type B and C) 2. Bleeding from the meatus, perineal injury or injury of the outer genital organs 3. Penetrating abdominal injury 4. In women only selectively after inspection Imaging of the extremities When fractures/dislocations are suspected: conventional imaging and selective CT