PURPOSE OF THE STUDY The study aimed to map the use of imaging techniques and results reporting in polytrauma patients by the trauma centres in the Czech Republic. MATERIAL AND METHODS The representatives of radiology departments and units of all 12 trauma centres in the Czech Republic completed a questionnaire regarding the imaging in polytrauma patients. RESULTS The Focused Assessment with Sonography for Trauma (FAST) as an initial imaging is used by all the centres, the WholeBody CT scan (WBCT) is the dominant imaging technique everywhere and all the centres have standards in place for its performance. The WBCT examination protocol varies across the centres, just like the evaluation procedures of the CT scan and reporting of the results over to the indicating physicians. In majority of centres, there is a high percentage of WBCT with normal findings. One of the centres which uses also X-rays as a part of imaging algorithm, reports a notably higher percentage of WBCT positive findings. DISCUSSION When considering the radiation dose, data and time necessary for WBCT, work required to assess the WBCT and a large number of negative findings, it is disputable whether in a number of cases the WBCT is a suitable method for polytrauma patient examination. Similar conclusions have been drawn also by other authors who recommend that the WBCT is always used for unconscious polytrauma patients, in whom a clinical examination is virtually impossible. In the other cases, based on the clinical parameters the other imaging techniques and the focused CT (and in the indicated cases also the wholebody CT) can be safely used. CONCLUSIONS he diagnostic procedure in a polytrauma patient is not uniform in trauma centres and even the procedure for urgent reporting of crucial WBCT findings to clinical physicians has not been standardised. In a number of cases the indication for WBCT seems to be unnecessary. A more careful consideration of indications for imaging examinations based on the clinical finding may reduce the radiation exposure of patients while maintaining the diagnostic accuracy. A structured report on WBCT in polytrauma is not used even though it is recommended by the European Society of Radiology. Key words:polytrauma, diagnostic imaging, Whole-Body Computed Tomography, structured report.
- MeSH
- Humans MeSH
- Tomography, X-Ray Computed methods statistics & numerical data MeSH
- Multiple Trauma diagnostic imaging epidemiology MeSH
- Health Care Surveys MeSH
- Radiation Exposure MeSH
- Retrospective Studies MeSH
- Trauma Centers statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
OBJECTIVES: This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS: The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS: Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION: Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.
- MeSH
- Aorta, Thoracic diagnostic imaging injuries MeSH
- Accidents, Traffic mortality statistics & numerical data MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Radiography MeSH
- Retrospective Studies MeSH
- Aortic Rupture diagnostic imaging epidemiology etiology mortality MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Trauma Centers statistics & numerical data MeSH
- Deceleration adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Hong Kong MeSH
- Keywords
- prevence dětských úrazů, mezinárodní porovnání,
- MeSH
- Child MeSH
- Accidents, Traffic mortality statistics & numerical data trends MeSH
- Humans MeSH
- Adolescent MeSH
- Accident Prevention * methods trends MeSH
- Preventive Medicine methods organization & administration trends MeSH
- Sex Distribution MeSH
- Schools statistics & numerical data legislation & jurisprudence MeSH
- Athletic Injuries mortality prevention & control MeSH
- Statistics as Topic MeSH
- Trauma Centers organization & administration statistics & numerical data utilization MeSH
- Accidents * mortality statistics & numerical data trends MeSH
- Accidents, Home mortality statistics & numerical data trends MeSH
- Government Programs * methods organization & administration utilization MeSH
- Leisure Activities MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Publication type
- Newspaper Article MeSH
- Geographicals
- Czech Republic MeSH
PURPOSE OF THE STUDY: Whole-body computed tomography is accepted as the standard procedure in the primary diagnostic of polytraumatised adults in the emergency room. Up to now there is still controversial discussion about the same algorithm in the primary diagnostic of children. The aim of this study was to survey the participation of German trauma-centres in the care of polytraumatised children and the hospital dependant use of whole-body computed tomography for initial patient work-up. MATERIAL AND METHODS: A questionnaire was mailed to every Department of Traumatology registered in the DGU (German Trauma Society) databank. RESULTS: We received 60,32% of the initially sent questionnaires and after applying exclusion criteria 269 (53,91%) were applicable to statistical analysis. In the three-tiered German hospital system no statistical difference was seen in the general participation of children polytrauma care between hospitals of different tiers (p = 0.315). Even at the lowest hospital level 69,47% of hospitals stated to participate in polytrauma care for children, at the intermediate and highest level hospitals 91,89% and 95,24% stated to be involved in children polytrauma care, respectively. Children suspicious of multiple injuries or polytrauma received significantly fewer primary whole-body CTs in lowest level compared to intermediate level hospitals (36,07% vs. 56,57%; p = 0.015) and lowest level compared to highest level hospitals (36,07% vs. 68,42%; p = 0.001). Comparing the use of whole-body CT in intermediate to highest level hospitals a not significant increase in its use could be seen in highest level hospitals (56,57% vs. 68,42%; p = 0.174). CONCLUSION: According to our survey, taking care of polytraumatised children in Germany is not limited to specialised hospitals or a defined hospital level-of-care. Additionally, there is no established radiologic standard in work-up of the polytraumatised child. However, in higher hospital care -levels a higher percentage of hospitals employs whole-body CTs for primary radiologic diagnostics in polytraumatised children.
- MeSH
- Child MeSH
- Humans MeSH
- Tomography, X-Ray Computed methods standards utilization MeSH
- Multiple Trauma radiography MeSH
- Health Care Surveys MeSH
- Child Health Services organization & administration standards statistics & numerical data MeSH
- Trauma Centers standards statistics & numerical data MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Germany MeSH
- Keywords
- třídící systém Emergency Severity Index,
- MeSH
- Stroke diagnosis therapy MeSH
- Humans MeSH
- Patient Admission * statistics & numerical data trends legislation & jurisprudence MeSH
- Trauma Centers organization & administration statistics & numerical data legislation & jurisprudence MeSH
- Triage * MeSH
- Hospital Rapid Response Team MeSH
- Emergency Service, Hospital * history organization & administration manpower statistics & numerical data trends MeSH
- Check Tag
- Humans MeSH
- MeSH
- Trauma Centers statistics & numerical data MeSH
- Publication type
- Tables MeSH
- Geographicals
- Czech Republic MeSH
- MeSH
- Comprehensive Health Care methods organization & administration trends MeSH
- Humans MeSH
- Spinal Cord Injuries complications MeSH
- Reference Standards MeSH
- Trauma Centers organization & administration statistics & numerical data trends MeSH
- Urological Manifestations MeSH
- Outcome and Process Assessment, Health Care methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
Je analyzována skupina raněných přeložených v roce 1997 do Úrazové nemocnice v Brně z jiných zařízení, ve kterých byli hospitalizováni od úrazu, pokud tato doba nepřesáhla 30 dnů. Takto byl přeložen 361 raněný. Důvody překladu jsou přehledně uvedeny. Za problematický je považován překlad 37 sdružené raněných a 30 raněných s monotraumatem. Při v současnosti uvažované redukci počtu zdravotnických, mimo jiné i chirurgiekých, pracovišť v České republice těžko obhájí právo na další existenci pracoviště, které není trvale schopno ošetrit i nekomplikovaná kostní poranění.
The author analyzes a group of casualties referred in 1997 to the Casualty Hospital Brno from other institutions where the patients were hospitalized after the injury, if the period did not exceed 30 days. Thus 361 casualties were referred. The reasons are summarized. Problematic is according to the author the admission of 37 patients with multiple injuries and 30 patients with a single injury. During the contemplated reduction of the number of health departments incl. surgical ones in the Czech Republic it will be difficult to justify the further existence of departments which are unable to cope permanently with uncomplicated bone fractures.
