A trauma CT results in a LOT of images (literally thousands). There is a balance between getting a quick report and getting a comprehensive report and as TTLs we need to understand this and manage patients accordingly.
- The first report (CT primary survey) is NOT comprehensive. It’s a way for our radiology colleagues to inform us of life threatening injuries. NEVER rely on this as a final/definitive report.
- All trauma scans will eventually be reported by a consultant radiologist. However, out of hours, and in some other hospitals, the first read may well be done by a doctor in training, or by a tele-radiology service. It is good practice to wait for a consultant review from our own expert team before considering a scan to be negative, and/or before discharging the patient.
- Always look at the CT scans yourself. This is not only good training for you, but as you will have seen the patient and injuries directly, you may be able to help radiological colleagues by identifying suspicious areas for early second looks. Although it is rare for immediately life threatening injuries to be missed, clinically important ones such as #sternum, #ribs, #transverse process, #spinous process, liver lacerations, other spinal fractures etc. are not infrequently missed on the first look.
- As TTL do your best to help our radiological colleagues to help us. If in doubt speak to them directly and work with them to give the best to our patients.
- Remember to check on the electronic record for report updates during secondary and tertiary surveys.
- If you get an update on a scan ensure that the information is forwarded to any relevant specialist team
- In the middle of the night when you don’t have a definitive report, it’s OK to put the patient on short stay if no major injuries found whilst you wait for the definitive report. Incidental findings and additional injuries can be found on roughly a third of scans in the ED. More evidence that the primary survey report should not be considered definitive.t
- Our radiologists don’t like to be disturbed, and there are good reasons for that as distractions can lead to mistakes. However, there are times when you need them in the room to discuss the findings and to clinically corroborate the findings. If you need them, then them.
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Refefences
- RCR guidelines on major trauma imaging. https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/major-adult-trauma-radiology-guidance/
- Evans CS, Arthur R, Kane M et al. Incidental radiology findings on computed tomography studies in emergency department patients: a systematic review and meta-analysis. Ann Emerg Med 2022; 80(3): 243–256
