La stratégie scanner corps entier systématique‎ : est-elle applicable aux traumatisés graves stables des urgences ?

Abstract : Introduction: The whole body computed tomography (CT) is usually used for early clinical assessment of major trauma patients. Its systematic implementation for multisystem trauma emergencies without signs of severity is controversial. The aim of our study was to determine whether the use of whole-body CT protocol is appropriate for this population. The main objective is to evaluate the correlation between clinical examination and CT-scan results. We also want to specify the characteristics of clinically silent lesions. Method: This retrospective observational study was conducted in Grenoble's hospital emergency department from January 2010 to December 2011. Were included conscious trauma patients without signs of vital distress who had received a whole-body CT. A doctor filled a posteriori general data forms, retrieving circumstances of trauma and clinical data contained in the medical record, as well as the results of whole-body scan. Statistical analysis was performed using Stata and Statview software. Results: 429 patients were included. The average age was 36 years (+ / -17) with 75 % men. The road accidents accounted for 52 % of injuries. The whole body CT found at least one lesion in 55% of patients. The kappa coefficient of agreement ranged from slight to moderate upon the different segments. All segments together, 103 asymptomatic lesions were found on CT. They were generally mild but led to urgent therapeutic interventions in some cases. Only three occult lesions were found in the brain. Conclusion: The frequency of asymptomatic lesion found is in favor of the systematic implementation of the whole body CT, brain scan aside, in blunt multisystem trauma emergencies.
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Master Thesis
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Jeanne Oberlin. La stratégie scanner corps entier systématique‎ : est-elle applicable aux traumatisés graves stables des urgences ?. Médecine humaine et pathologie. 2013. ⟨dumas-00875896⟩

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