Skip to main content
. 2020 Dec 5;16:106–113. doi: 10.1016/j.jcot.2020.12.006

Table 2.

Bedside and Whole Body CT Protocols in Stable, Unstable Blunt and penetrating Trauma:6.

Hemodynamic status of the patient Beside imaging WBCT protocol and modifications Additional comments

  • Stable blunt trauma patient.

  • •

    Patients with high-energy mechanisms of injury should generally undergo whole body CT (WBCT): Table 1
  • •

    Radiographs and EFAST are not required since WBCT is accepted initial modality of choice.

  • •

    Likewise, when WBCT is considered pelvic radiographs can be ommited.
  • •

    WBCT scan with IV contrast. Head CT and COW angiogram as indicated (Table 3)

  • •

    Target completion time is 30min,

  • •

    WBCT in stable patients need not be accompanied by the trauma team during the transport and imaging.
  • •

    Common important occult injuries not easily identified without WBCT include: intracranial hemorrhage, blunt cervical vascular injury, facial fractures, spinal fractures, rib fractures, pneumothoraces, blunt aortic injury, abdominal visceral injury and retroperitoneal hemorrhage
Unstable responding to resuscitation
  • •

    An unstable patient is any patient at high risk for physiologic deterioration.

  • •
    Commonly, though not exclusively, such patients present with:
    • 1.
      Hypotension,
    • 2.
      Hypoxia/respiratory distress
    • 3.
      Obtundation or impaired consciousness
  • •

    Chest XR (supine) -for detecting major pneumothorax and major hemothorax.

  • •

    Extended Focused Assessment with Sonography for Trauma (E-FAST)-to visualize free fluid in the pleural, pericardial, perihepatic, perisplenic, and pelvic locations and pneumothorax in the anterior pleura.

  • •

    Pelvic XR - recommended for mechanically unstable pelvis on initial assessment, or there is concern that occult pelvic injury is present and responsible for occult hemorrhage, then a pelvic binder should be applied prior to bedside pelvic imaging or before transfer of patient for CT.

  • •

    Urethrogram -rarely performed. If there is strong suspicion of urethral injury and attempt to catheterisation fails, intraoperative suprapubic catheter is placed.

  • •

    Lateral cervical spine plain X ray a cross-table lateral c-spine radiograph to rule out atlanto- occipital dislocation or other severely displaced c-spine fracture, which portends a poor. RCR however, recommends CT scan for cervical spine clearance.
  • •

    WBCT scan with IV contrast. Head CT and COW angiogram as indicated.

  • •

    Target completion time is 15min and trauma team

  • •

    Standard monitoring required. Monitoring and supervision by a physician-led trauma team including nursing and respiratory therapy is required.
  • •

    Bed side imaging protocol in unstable patients remains same both in responders to resuscitation and transient responders to resuscitation.

  • •

    Bedside imaging plays a key role in this process and should be limited only to studies that will meaningfully advance the care of the patient in an efficient and prioritized manner.

  • •

    WBCT studies for trauma may be augmented by additional focused CT imaging when clinically indicated by the finding of major extremity trauma on initial assessment. This may include focused CT imaging of joints and fractures with corresponding CT angiography to rule out associated vascular injury.
Unstable transiently responding to resuscitation
In some cases, initially unstable patients will respond to resuscitation only briefly or transiently (transient responders) indicating that more physiologically active injuries are present.		 Imaging protocol same as above. The key diagnostic information sought in this instance is the presence or absence of:
  • 1.

    Intracranial hemorrhage and intracranial hypertension

  • 2.

    Cervical spine instability

  • 3.

    Major blunt cervical vascular injury

  • 4.

    Pneumothoraces

  • 5.

    Blunt aortic disruption with contained or free extravasation

  • 6.

    Major diaphragmatic/major visceral injury

  • 7.

    Unstable thoracolumbar fracture pelvic fracture associated with active arterial or venous hemorrhage

 The use of WBCT in transient responders is more controversial, but still valuable and feasible if ongoing physiologic support can be maintained during imaging, and scanning can be completed extremely rapidly in a safe setting in direct proximity to the emergency department.
Stable Penetrating trauma Radiographs are indicated based on severity of injury. WBCT is not recommended.
Focused CT imaging of affected body region is recommended in stable patients with penetrating trauma. Depending on location of injury, intravenous, oral and/or rectal contrast is recommended.
Unstable penetrating trauma Chest Radiograph: Assess for pneumothorax
E-FAST ultrasound: Assess for hemoperitoneum/hemopericardium/pneumothorax
Additional radiographs to identify penetrating objects and their trajectories (head, neck, etc.)		 CT is contraindicated in hemodynamically unstable patients with penetrating trauma.