EuroSafe Imaging 2020
Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide), Emergency, Neuroradiology brain, Trauma, CT, Audit and standards, Retrospective, Observational, Performed at one institution
M. Al-Mahtot, N. McCarville, K. Luckyram, A. Tighilt, K. Tekle, E. Sharma
Trauma is the most common cause of death in patients under 40 years old. The Royal College of Radiologists (RCR) have issued standards and guidance for trauma radiology in severely injured patients (SIPs) . Their recommendations include that “definitive imaging will most often be head-to-thigh contrast-induced multi-detector computed tomography (MDCT)” and “there may be indications for plain digital radiography, but these should never delay an MDCT if a decision has been taken early that this is the imaging modality of choice”. Whole-body MDCT has been shown to be a predictor of survival in SIPs when compared to no CT or targeted CT. In addition, the British Orthopaedic Association and British Society of Spine Surgeons do not recommend plain films of the cervical spine in SIPs, and their standard of practice for cervical spine clearance is CT.
For patients presenting with head injury alone, there are 12 clear indications outlined by the National Institute for Health and Care Excellence (NICE) for CT head in adults: 7 of these require scanning within one hour and 5 require scanning within 8 hours of the injury.
The RCR guidelines in paediatric trauma are different to those for adults, with the aim of minimising radiation exposure. RCR rightly point out that children “are not just small adults”. For each individual case one should consider “does this child need imaging at all?”. Recommended imaging for paediatric trauma to the head and abdomen continues to be CT, while chest should be imaged with plain films and c-spine imaging entrails either plain film or CT depending on the clinical scenario and pelvis rarely needs any imaging at all.
Once a CT has been performed, the report should be issued within a one hour time time frame.
St Peter’s hospital is a 400-bed district general hospital in Surrey lying just outside the M25 with a busy Accident and Emergency department seeing nearly 100,000 patients per annum. It is part of the South West London and Surrey Trauma system and is supported by St George’s Hospital a Major Trauma Unit.
This audit examines whether the guidelines set out by the RCR and NICE are being adhered to in our institution and identify areas for improvement.