Severely Injured Patients

• Severely injured patients (SIPs) are defined as having an Injury Severity Score (ISS) of >15 
• The ISS is calculated by assigning an Abbreviated Injury Scale (AIS) of 1-6 to 9 body areas

Fig. 1: Injury Severity Score

• SIPs should be transferred to a Major Trauma Centre (MTC) unless they are more than 45 minutes from the nearest centre; require stabilisation or are trapped for extended periods
• If the above circumstances apply, SIPs will attend a Trauma Unit (such as our centre) and may be subsequently transferred to the MTC
• SIPs often require whole body multi-detector CT (MDCT) to survey for acute severe injuries
• MDCT is discussed as part of the Regional Networks for Major Trauma report by NHS England, with support from the National Clinical Director for Trauma Care

Guidelines

• The Royal College of Radiologists (RCR) released guidelines for trauma radiology in 2015
• Derived from the Regional Networks for Major Trauma NHS Clinical Advisory Groups Report from 2010
• Outline 20 recommended standards
• Nine standards apply specifically to trauma MDCT

Request Criteria

• Requests should comply with Ionising Radiation (Medical Exposure) Regulations (IRMER) justification the same as any other request
• SIPs must fulfil one of the 4 criteria to justify the request for a whole body MDCT

Fig. 2: Trauma MDCT Request Criteria

Road Traffic Collisions:

The RCR guidelines do not define "high speed impact". Maximum Abbreviated Injury Score is used in Safe Systems discussions to define fatal and serious injury (MAIS3+). A probability of MAIS3+ of 10% is considered a critical threshold.

Fig. 7: Critical speeds for "high speed impact" in different road traffic accidents morphology.

Fall down stairs:

Many requests include a fall down a single flight of stairs. Building regulations stipulate a typical total staircase is 2.6 metres and therefore does not fulfil the request criteria.

Fig. 3: Buildings regulations standard dimensions for a single domestic flight of stairs.
References: © Radiology, East and North Herfordshire NHS Trust, Lister Hospital - Stevenage/UK