Low Yield of Clinically Significant Injury With Head-To-Pelvis Computed Tomography in Blunt Trauma Evaluation

J Emerg Med. 2017 Dec;53(6):865-870. doi: 10.1016/j.jemermed.2017.08.036. Epub 2017 Oct 28.


Background: Many trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma.

Objective: We sought to determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region.

Methods: We conducted this observational cohort study of all trauma activation patients >14 years of age who received CT imaging during blunt trauma evaluation at a Level 1 trauma center from April to October 2014. Expert panels determined the clinical significance of head, neck, chest, abdomen, and pelvis injuries seen on CT. We calculated yields of CSI, defined as the number of patients with CSI divided by the total number of patients who underwent CT imaging. The 3 specified anatomic regions considered were head/neck, chest, and abdomen/pelvis.

Results: The median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6-13.3%); chest region injury only 7.9% (6.0-10.4%); abdomen/pelvis region injury only 5.1% (3.7-7.0%); both head/neck and chest CSI 2.8% (1.7-4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9-2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5-2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2-1.7%), and 76.7% (68.8-83.1%) of CSIs occurred in isolation.

Conclusions: During multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.

Keywords: CT; diagnostic yield; head-to-pelvis computed tomography; pan-scan; selective imaging; whole-body CT; yields of CT.

MeSH terms

  • Abdominal Injuries / diagnosis*
  • Abdominal Injuries / epidemiology
  • Adult
  • Aged
  • Clinical Decision-Making / methods*
  • Cohort Studies
  • Craniocerebral Trauma / diagnosis*
  • Craniocerebral Trauma / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Thoracic Injuries / diagnosis*
  • Thoracic Injuries / epidemiology
  • Tomography, X-Ray Computed / methods*
  • Tomography, X-Ray Computed / standards
  • Tomography, X-Ray Computed / statistics & numerical data
  • Trauma Centers / statistics & numerical data