TABLE 1:
CT Scan in Head Injuries Selection of adults for CT Scan
Urgent scan if any of the following (results within 1 hour)
• Glasgow Coma Scale (GCS) <13 when first assessed or GCS <15 two hours after injury
• Suspected open or depressed skull fracture • Signs of base of skull fracture* • Post-traumatic seizure • Focal neurological deficit • >1 episode of vomiting (SIGN guidance suggests 2 distinct episodes of vomiting)
• Coagulopathy + any amnesia or loss of consciousness since injury
special attention to the pouch of Douglas, and the pericardium. MDCT Scan: Although CT uses ionizing radiation and requires injection of iodinated contrast material, these drawbacks of CT are far outweighed by its benefits. Injury severity scores are widely used,
such as the organ injury scaling system (OIS) of the American Association for the Surgery of Trauma. Since a variety of criteria can be assessed on the basis of CT, radiologists involved in trauma care should be familiar with the principles of grading injuries to the different visceral organs.
CONCLUSION Over the years modern imaging modalities has become the coroner stone of management of trauma victims. In an emergency situation, the patient’s time, early and accurate diagnosis, and initiation of treatment have profound influence on the patient’s outcome. Variable imaging modalities are involved in trauma patient assessment; however, optimizing the use of imaging procedures is of vital importance. The goal of this article is to address
the current concepts of imaging trauma patients. Since a variety of criteria can be assessed on the basis of CT, radiologists involved in trauma care should be familiar with the principles of grading injuries to the different visceral organs. ■
AH
«In an emergency situation, the patient’s time, early and accurate diagnosis, and initiation of treatment have a profound influence on the patient’s outcome»
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A CT scan is also recommended (within 8 hours of injury) if there is either
• More than 30 minutes of amnesia of events before impact
• Or any amnesia or loss of consciousness since injury if:
- Aged ≥65 years - Coagulopathy or on warfarin - Dangerous mechanism of injury - Road traffic accident (RTA) as a pedestrian - RTA - ejected from car - Fall >1 m or >5 stairs
TABLE 2:
CT Scan in Head Injuries Selection of children for CT Scan Selection (under 16 years)
Urgent scan if any of the following: •Witnessed loss of consciousness >5 minutes
•Amnesia (antegrade or retrograde) >5 minutes
•Abnormal drowsiness • ≥3 Discrete episodes of vomiting • Clinical suspicion of nonaccidental injury • Post-traumatic seizure (no PMH of epilepsy)
• GCS <14 in emergency room (Paediatric GCS <15 if aged <1)
• Suspected open or depressed skull fracture or tense fontanelle
• Signs of base of skull fracture* • Focal neurological deficit •Aged <1 - bruise, swelling or laceration on head >5 cm
• Dangerous mechanism of injury (high-speed RTA, fall from >3 m, high-speed projectile)
*Signs of basal skull fracture: haemotympanum, ‘panda’ eyes (bruising around the eyes), cerebrospinal fluid (CSF) leakage (ears or nose) or Battle’s sign (bruising which sometimes occurs behind the ear in cases of basal skull fracture).
REFERENCES References available on request (
magazine@informa.com)
LEARN MORE
The 12th Middle East Medical Imaging and Diagnostics conference is taking place at Arab Health 2012 from 23rd- 25th January. The conference is aimed at all those involved in the field of radiological science and will present the latest advances in medical imaging and diagnostics. International experts from around the globe will be present to share their knowledge and know-how. To find out more and to register you place as a delegate, visit the website:
www.arabhealthonline.com
TABLE 3: Grading scales for organ injuries (according to OIS)
A) Grading of liver injury: Grade Finding I Capsular avulsion, superficial laceration(s) <1 cm deep, subcapsular hematoma <1 cm II Laceration(s) 1–3 cm deep, central/subcapsular hematoma(s) 1–3 cm III Laceration(s) >3 cm deep, central/subcapsular hematoma(s) >3 cm IV Massive central/subcapsular hematoma >10 cm, lobar tissue destruction or devascularization V Bilobar tissue destruction or devascularisation.
B) Grading of splenic injury: Grade Finding I Subcapsular or intrasplenic hematoma II Capsular disruption or superficial parenchymal tears (_1 cm) Ill Deep parenchymal tears (>1 cm) without hilar involvement IV Parenchymal tears with hilar involvement V Fragmentation of spleen
C) Grading of renal injury: Grade I: subcapsular hematoma (arrow) with intact capsule Grade II: superficial cortical laceration <1cm (arrow) with confined peri-renal hematoma (arrowhead) without urinary extravasation. Grade III: deep laceration > 1 cm (arrows) without injury to collecting system. Grade IV: laceration extending into the collecting system with urine extravasation. Grade V: shattered kidney, renal vascular pedicle injury, devascularized kidney.
D) Grading of pancreatic injury Grade Finding Grade I minor contusion, superficial laceration without duct injury. Grade II major contusion, deep laceration (>50% pancreatic thickness) without duct injury or tissue loss.
Grade III distal transaction or parenchymal injury with duct injury. Grade IV proximal transaction or parenchymal injury involving the ampulla or bile duct. Grade V massive disruption of the pancreatic head.
E) Grading of aortic injury: CT grading system has been proposed in the estimation of the severity of aortic injury Grade 0 normal aorta and mediastinum. Grade 1 abnormal mediastinum and normal aorta. Five to 10% of blunt trauma present with isolated mediastinal hematoma in the absence of an aortic lesion. Grade 2 minimal aortic injury. Aortic intimal injuries extending for 1 cm or less may be difficult to detect and should be differentiated from atherosclerotic plaques. Grade 3 confined aortic injury. This is the most common type of aortic lesion, easily identified due to the formation of pseudoaneurysm. Grade 4 total aortic disruption. The aortic contour is irregular, poorly defined, and contrast medium extravasation into the extra-adventitia space is visible.
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