Computed tomography for occult fractures of the proximal femur,pelvis, and sacrum in clinical practice: single institution,dual-site experience

Purpose

The purpose of this study was to evaluate the diagnostic performance of CT for assessment of occult fractures of the proximal femur, pelvis, and sacrum.

Materials and methods

A retrospective review was performed on patients who received a CT of the hip or pelvis for suspected occult fracture after negative or equivocal radiographs performed within 24 h. The official radiology report was utilized for the determination of CT findings and calculation of sensitivity and specificity. Surgical reports, MRI reports, and clinical follow-up were used as the standard of reference. Sensitivity and specificity were calculated with 95% confidence intervals.

Results

Seventy-four patients received CT of the hip or pelvis for clinical concern for occult fracture after negative or equivocal radiographs. By the reference standard, a total of 40 fractures were present in 25/74 (33.8%) patients, including 35 conservatively treated fractures of the greater trochanter, pelvis, and sacrum, and 5 operatively treated proximal femoral fractures. A total of 14/74 (18.9%) of patients had an MRI within 1 day of CT. MRI identified an operatively treated femoral neck fracture not seen on CT and an operatively treated intertrochanteric fracture, which CT described as a greater trochanteric fracture. There were two false negative conservatively treated pelvic fractures not seen on CT but diagnosed on MRI. On a per-patient basis, CT had an overall sensitivity of 88% (22/25; 95% confidence intervals 69–97%), specificity of 98% (48/49; 95% confidence intervals 89–100%), and negative predictive value of 94%. For the five operative proximal femoral fractures, the sensitivity of CT was 60% (3/5; 95% confidence intervals 15–95%), specificity was 99% (68/69; 95% confidence intervals 92–100%), and negative predictive value was 97%.

Conclusions

In the clinical setting of suspected occult fracture, the sensitivity of clinical CT reports for detection of any type of fracture of the proximal femur, pelvis, or sacrum was 88%. For the small number of operatively treated proximal femoral fractures seen in the study, sensitivity of CT was 60% (3/5) and negative predictive value was 97%, although the relatively few patients needing fixation precludes statistical analysis.

     

Computed tomography compared to magnetic resonance imaging in occult or suspect hip fractures. A retrospective study in 44 patients

Background

Computed tomography (CT) for evaluation of occult and suspect hip fractures has been proposed as a good second-line investigation. The diagnostic precision compared to magnetic resonance imaging (MRI) is unclear.

Purpose

To compare the diagnostic performance of CT and MRI in a retrospective study on patients with suspect and occult hip fractures.

Material and methods

Forty-four elderly consecutive patients with low-energy trauma to the hip were identified where negative or suspect CT was followed by MRI. Primary reporting and review by two observers as well as the diagnostic performance of the two modalities were compared. Surgical treatment and clinical course were used as outcomes.

Results

Compared to the primary reports, the CT reviewers found fewer normal and no suspect cases. MRI changed the primary diagnoses in 27 cases, and in 14 and 15 cases, respectively, at review. There was no disagreement on MRI diagnoses.

Conclusion

In our patient population, MRI was deemed a more reliable modality for hip fracture diagnosis in comparison to CT. For clinical decision making, MRI seems to have a higher accuracy than CT. A negative CT finding cannot completely rule out a hip fracture in patients where clinical findings of hip fracture persevere.

Key Points

? Experience is highly influential in diagnosing occult or suspect hip fractures at CT ? Inconclusive hip CT shows high inter-rater reliability at experienced review ? There was low diagnostic accuracy via CT compared to MRI for all interpreters ? Hip fractures can readily be diagnosed at MRI regardless of radiological experience

     

CT characteristics of traumatic sacral fractures in association with pelvic ring injuries: correlation using the Young-Burgess classification system

Purpose

The purpose of the study is to determine the incidence of sacral fracture patterns on CT imaging of pelvic trauma patients with correlation with mechanism of injury and pelvic ring injury pattern using the Young-Burgess classification system.

Materials and methods

This is a retrospective review of all pelvic CTs with pelvic fractures performed at our level 1 trauma center during a 4-year period from July 2010 to June 2014.

Results

Sacral fractures were very common in pelvic trauma patients, being present in 60% of patients presenting to our institution with pelvic fractures. Longitudinal fractures were almost always associated with additional pelvic ring injuries. Denis zone 1 fractures had the highest association with lateral compression pelvic ring injuries. Denis zone 2 and 3 fractures were seen with increased frequency in AP compression and vertical shear injuries. A third of transverse sacral fractures occurred in isolation, with isolated transverse sacral fractures typically occurring in the low (S3–S5) sacrum. Almost half of combined transverse and longitudinal sacral fractures occurred without an additional pelvic fracture present. Sacral avulsions almost always occurred as part of a pelvic ring fracture pattern, most commonly in AP compression injuries. Coccyx fractures frequently occurred in isolation, but were commonly seen in vertical shear injuries when associated with a pelvic ring injury pattern.

Conclusion

Avulsion fractures and longitudinal fractures of the sacrum are almost always associated with anterior pelvic ring injury. Conversely, transverse fractures of the lower sacrum and combined longitudinal and transverse sacral fractures are prone to occur in isolation.

     

<Emphasis Type="Bold">Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT</Emphasis>

Purpose

To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT.

Methods

A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome.

Results

A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management.

Conclusions

MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination.

Key Points

? MRI has limited utility after negative cervical CT in blunt trauma.? MRI is frequently positive for non-specific soft-tissue injury.? Unstable injury missed on CT is infrequent.

     

Revisiting the indirect signs of a temporal bone fracture: air,air, everywhere

Background and purpose

The standard head CT protocol makes detection of a temporal bone fracture difficult. The purposes of our study are to revisit the finding of air in various locations around the temporal bone as an indirect sign of fracture and determine if findings could predict fracture pattern.

Materials and methods

We searched the radiology reports for the keyword “temporal bone fracture.” We recorded the presence of air in multiple locations around the temporal bone and pneumocephalus, opacification of the mastoid air cells or the middle ear cavity, and dominant fracture pattern. Statistical analyses were performed using statistical software.

Results

A total of 135 patients (mean age 40 ± 20.1 years, 101 male, 34 female, range 1–91) had 152 fractures. At least one indirect finding was present in 143 (94.1%) fractures. Air was present adjacent to the styloid process in 94 (61.8%), in the temporomandibular joint in 80 (52.6%), adjacent to the mastoid process in 57 (37.5%), and along the adjacent dural venous sinus in 33 (21.7%) fractures. Mastoid opacification was present in 139 (91.4%) fractures. Opacification of the middle ear cavity was present in 121 (79.6%) fractures. A complex fracture significantly and positively correlated with pneumocephalus.

Conclusion

In the setting of trauma, air around the temporal bone and opacification of the mastoid air cells or middle ear cavity should prompt consideration of a temporal bone fracture even if the fracture line is not visible. The presence of pneumocephalus predicts a higher chance of complex fracture pattern.

     

Fractures of the posterolateral maxillary sinus: a masticator space blowout injury?

Background and purpose

Segmental, depressed fractures of the posterolateral maxillary sinus may occur as a result of trauma to the masticator space, previously described in association with mandibular fractures. The authors hypothesize that the fracture is due to a transient increase in pressure in the masticator space (blow out) and therefore should be seen in association with other regional fractures.

Materials and methods

Injuries of the masticator space were retrospectively identified by searching the imaging database from January 2014 to November 2014 for keywords that would identify regional trauma. The images were reviewed for segmental depressed fractures in the posterolateral aspect of the maxillary sinus accompanied by herniation of a variable amount of masticator space fat and/or muscle into the adjacent sinus. Three neuroradiologists reviewed the images and agreed by consensus on the presence or absence of a masticator space blowout fracture.

Results

Forty-three zygomaticomaxillary complex (ZMC) fractures, 89 mandibular fractures, and 49 isolated zygomatic arch fractures were identified. While all of the ZMC fractures had a maxillary component, 3 of 43 (7.0 %) additional fractures met our fracture definition. Five of 89 (5.6 %) of the mandibular fractures and 6 of 49 (12.2 %) zygomatic arch fractures had an associated posterolateral maxillary fracture.

Conclusions

Segmental depressed fracture of the posterolateral maxillary sinus is relatively common, occurring in conjunction with other regional injuries. The authors hypothesize that it is due to a transient increase in pressure in the masticator space and is a separate entity from other fractures of the region that may occur concurrently.

     

Association of femoral head and acetabular fractures on computerized tomography: correlation with the Judet-Letournel classification

Purpose

Tha aims of this study were to identify the incidence of femoral head fractures in the setting of acetabular fractures and to determine the relationship between acetabular fracture pattern, the degree of acetabular fracture displacement, and the incidence of femoral head fractures.

Materials and methods

This is a retrospective cross-sectional study of 274 patients with 300 acetabular fractures diagnosed on pelvic CT. Acetabular fractures were categorized using the Judet-Letournel classification system.

Results

Femoral head fractures were present in 18.0% of acetabular fractures. Fracture patterns with a posterior wall component had a very high (56.3%) incidence of femoral head fracture. Anterior column and anterior column with posterior hemitransverse fractures have a very low (3.4%) incidence of femoral head fracture. Anterior hip dislocation had a 66.7% incidence of femoral head fracture, while posterior dislocation had a 71.9% incidence. Acetabular fractures displaced by more than 5 mm had a 26.9% incidence of femoral head fracture, while acetabular fracture displaced less than 5 mm had only 4.2% incidence of femoral head fracture.

Conclusion

Femoral head fractures are a very common associated finding in patients presenting with acetabular fractures. In patients with a posterior wall component of the fracture or associated hip dislocation, a femoral head fracture is more likely than not present. Conversely, in acetabular fractures with less than 5 mm displacement or anterior column fractures without posterior acetabular involvement, femoral head fractures are very unlikely in the absence of a dislocation event.

     

Distracting injury defined: does an isolated hip fracture constitute a distracting injury for clearance of the cervical spine?

Objectives

As the population within the USA ages, the number of hip fractures seen yearly in the emergency department is expected to rise. According to the NEXUS criteria, many of these patients receive computerized tomographic scan (CT) evaluation of the cervical spine because a hip fracture may constitute a distracting injury. The objective of this study is to determine if an isolated hip fracture constitutes a distracting injury which requires imaging of the cervical spine.

Methods

Data were prospectively collected on 158 trauma patients with isolated hip fractures between April 1, 2015 and March 9, 2016. Patient demographics were analyzed and compared to the National Emergency X-Radiography Utilization Study (NEXUS).

Results

Patients with isolated hip fractures were predominantly elderly, on average 78.6 +/? 15.9 years old, and 94.3% of these injuries occurred after a fall from standing. Only one patient also had a cervical spine fracture which was not clinically significant. When compared to the established rate of cervical spine injury of 2.4%, the absolute risk reduction (ARR) was 0.35% (95% CI, ? 1.06 to 1.75%) and the number needed to treat (NNT) was 290.

Conclusion

In the case of an elderly patient with an isolated hip fracture and no cervical midline tenderness, cervical spine imaging may be reserved for those who have other NEXUS criteria for further workup.

     

Number of positive radiographic findings in pediatric trauma patients

Purpose

Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically.

Methods

A transversal cohort study was conducted at a level 1 trauma center in Germany (2008–2014). In a statistical pre hoc analysis, a sample size of 200 images of each standard radiograph was determined. The picture archiving and communication system (PACS) was searched for radiographic examinations in patients under 18 years.

Results

The following fracture rates for the investigated 20 most common examinations were found: 70.5% clavicle, 54.5% forearm, 53% wrist, 41.5% elbow, 30.5% lower leg, 20% hand, 18.5% finger, 12.5% toe, 12% forefoot, 11.5% ankle, 9% shoulder, 6.5% patella, 5.5% foot, 4% knee, 2% conventional rib series, 1.5% lumbar spine, 1% Towne view, 0.5% skull, 0% cervical spine, and 0% odontoid. Differences in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs were found.

Conclusions

In our study, a relevant amount of different standard radiographs revealed a low fracture rate. Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents. Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs.

     

Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

Background

In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.

Methods

Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively.

Results

One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions.

Conclusions

In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group.

Level of Evidence

Level III. Diagnostic study of non-consecutive patients.

     

Color postprocessing of conventional CT images: preliminary results in assessment of nondisplaced proximal femoral fractures

Purpose

The purpose of this study was to demonstrate the diagnostic performance and effect on reader confidence of a custom computed tomography (CT) color postprocessing algorithm for assessment of nondisplaced proximal femoral fractures.

Materials and methods

Four radiologists, including two PGY-3 radiology residents and two emergency radiologists, independently interpreted 30 CT examinations of the hip and/or pelvis performed for trauma, consisting of a total of 15 cases positive for nondisplaced hip fracture and 15 age and sex-matched controls. Images were reviewed first with conventional CT images and after at least 8 weeks, all images were reviewed again with the addition of coronal color postprocessed images. Sensitivity and specificity were compared with McNemar’s test, and diagnostic confidence was compared with paired t tests.

Results

There was no significant difference in diagnostic performance between conventional and postprocessed images, although there was nominally increased sensitivity and decreased specificity with the postprocessed images: for all readers, the sensitivity and specificity for conventional images was 88.3 and 95.0%, compared to 93.3% (p?=?0.25) and 88.3% (p?=?0.14) for postprocessed images. Three of four readers (including both attending radiologists) reported an increase in confidence with postprocessed images for cases negative for fracture (10-point confidence scale of 7.25 for conventional images, compared to 8.2 for postprocessed images for all readers, p?=?0.0053). There was no difference in diagnostic confidence for cases positive for fracture.

Conclusions

A custom color CT postprocessing algorithm did not demonstrate a significant difference in diagnostic performance for assessment of nondisplaced proximal femoral fractures within the limitations of a relatively small sample size; however, postprocessing increases confidence of experienced readers in cases negative for fracture.

     

Proton density fat fraction (PDFF) MR imaging for differentiation of acute benign and neoplastic compression fractures of the spine

Objectives

To evaluate the diagnostic performance of proton density fat fraction (PDFF) magnetic resonance imaging (MRI) to differentiate between acute benign and neoplastic vertebral compression fractures (VCFs).

Methods

Fifty-seven consecutive patients with 46 acute benign and 41 malignant VCFs were prospectively enrolled in this institutional review board approved study and underwent routine clinical MRI with an additional six-echo modified Dixon sequence of the spine at a clinical 3.0-T scanner. All fractures were categorised as benign or malignant according to either direct bone biopsy or 6-month follow-up MRI. Intravertebral PDFF and PDFF_ratio (fracture PDFF/normal vertebrae PDFF) for benign and malignant VCFs were calculated using region-of-interest analysis and compared between both groups. Additional receiver operating characteristic and binary logistic regression analyses were performed.

Results

Both PDFF and PDFF_ratio of malignant VCFs were significantly lower compared to acute benign VCFs [PDFF, 3.48 ± 3.30% vs 23.99 ± 11.86% (p < 0.001); PDFF_ratio, 0.09 ± 0.09 vs 0.49 ± 0.24 (p < 0.001)]. The areas under the curve were 0.98 for PDFF and 0.97 for PDFF_ratio, yielding an accuracy of 96% and 95% for differentiating between acute benign and malignant VCFs. PDFF remained as the only imaging-based variable to independently differentiate between acute benign and malignant VCFs on multivariate analysis (odds ratio, 0.454; p = 0.005).

Conclusions

Quantitative assessment of PDFF derived from modified Dixon water-fat MRI has high diagnostic accuracy for the differentiation of acute benign and malignant vertebral compression fractures.

Key Points

? Chemical-shift-encoding based water-fat MRI can reliably assess vertebral bone marrow PDFF ? PDFF is significantly higher in acute benign than in malignant VCFs ? PDFF provides high accuracy for differentiating acute benign from malignant VCFs

     

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

Purpose

Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN.

Methods

We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months.

Results

Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively.

Conclusions

According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

     

Systematik der Verletzungen von Rotatorenmanschette und Bizepssehne

Performance

Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically.

Achievements

These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury.

Practical recommendation

Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns.

     

Image classification for Die-punch fracture of intermediate column of the distal radius

Objective

The aim of the study was to analyze the imaging findings of Die-punch fracture of intermediate column of the distal radius, and to explore the clinical application value of image classification.

Methods

The clinical data of 45 patients who were admitted to our hospital from May 2010 to October 2016 were analyzed retrospectively. All patients met the inclusion criteria for Die-punch fracture. X-ray and CT scan were performed to examine the fracture, and the results were assessed by two doctors in a double blind method. Finally, the image classification of Die-punch fracture was formulated.

Results

According to the imaging features of Die-punch fracture, it was divided into four types: type I (dorsal type, 15 cases), type II (volar type, 8 cases), type III (splitting type, 10 cases), type IV (collapsed type, 12 cases). The accuracy rate of CT was 100% (45/45). The misclassification rate of X-ray was 15.6% (7/45) and the missed diagnosis rate was 11.1% (5/45).

Conclusions

CT examination could accurately diagnose Die-punch fracture and perform preoperative image classification.

     

Predictors of active arterial hemorrhage on angiography in pelvic fracture patients

Purpose

To determine predictors of active angiographic hemorrhage in pelvic fracture patients.

Materials and methods

This retrospective study included 66 trauma patients who had major hemorrhages due to pelvic fractures, and who underwent pelvic angiography between January 2012 and December 2014. The study population comprised 31 males and 35 females (mean age 44.2 ± 20.7 years). The main outcome was active hemorrhage on pelvic angiography. Clinical and imaging variables including demographics, hemodynamic parameters, injury severity, types of pelvic fracture, laboratory data, blood transfusions and CT findings were analyzed. Multivariate logistic regression was used to identify predictors of active angiographic hemorrhage.

Results

Of the 66 study patients included, 41 patients had active angiographic hemorrhage. These patients had more blood transfusions, higher activated partial thromboplastin times and higher rates of contrast extravasation on CT (p < 0.05). Three independent predictors of active angiographic hemorrhage were identified, including contrast extravasation on CT (OR: 74.6, p < 0.001), more than 8 units of RBC transfusions (OR: 12.5, p = 0.018) and ISS ≥ 16 (OR: 11.1, p = 0.029).

Conclusion

Contrast extravasation on CT, high volume RBC transfusions and ISS ≥ 16 can help us to select pelvic fracture patients for angiography more precisely.

     

Percutaneous osteosynthesis in the pelvis in cancer patients

Purpose

Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. We report our experience in cancer patients.

Material/methods

We retrospectively reviewed all cases of percutaneous osteosynthesis (PO) of the pelvic ring and proximal femur performed in our hospital. PO were performed for fracture palliation or for osteolytic metastases consolidation. Screws were inserted under CT- or cone-beam CT- guidance and general anaesthesia. Patients were followed-up with pelvic-CT and medical consultation at 1 month, then every 3 months. For fractures, the goal was pain palliation and for osteolytic metastases, pathologic fracture prevention.

Results

Between February 2010 and August 2014, 64 cancer patients were treated with PO. Twenty-one patients had PO alone for 33 painful fractures (13 bone-insufficiency, 20 pathologic fractures). The pain was significantly improved at 1 month (VAS score?=?20/100 vs. 80/100). In addition, 43 cancer patients were preventively consolidated using PO plus cementoplasty for 45 impending pathologic fractures (10 iliac crests, 35 proximal femurs). For the iliac crests, no fracture occurred (median-FU?=?75 days). For the proximal femurs, 2 pathological fractures occurred (fracture rate?=?5.7 %, median-FU?=?205 days).

Conclusion

PO is a new tool in the therapeutic arsenal of interventional radiologists for bone pain management.

Key Points

? Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. ? CT- or CBCT-guidance results in high technical success rates for screw placement. ? This minimally invasive technique avoids extensive surgical exposure in bone cancer patients. ? Osteosynthesis provides pain relief for bone-insufficiency fractures and for pathologic fractures. ? Osteosynthesis plus cementoplasty provide prophylactic consolidation of impending pathological fractures.

     

An assessment of repeat computed tomography utilization in the emergency department in the setting of blunt trauma

Purpose

Computed tomography (CT) is a standard imaging modality utilized during the evaluation of trauma patients in the emergency department (ED). However, while it is common to utilize intravenous (IV) contrast as an adjunct, the use of multiple CT scans and how it impacts patient flow can lead to changes in patient management. Our objectives are to assess length of stay (LOS) and rates of acute kidney injury (AKI), when two CT scans of the abdomen/pelvis are performed compared to one CT scan.

Methods

Data of trauma hospital encounters were retrospectively collected during a 5-year period at a large, level 1 trauma center. Encounters were categorized into patients who received one or two CT scans of the abdomen/pelvis, as well as if they had received IV contrast or not. CT scan reads were extracted from chart records, and groups were compared.

Results

Of 5787 patient encounters, 5335 (93.4%) received IV contrast and 75 (1.3%) received two CT scans. Lower rates of AKI were associated with IV contrast (2.5 vs 12.5%). Receiving two CT scans was associated with increased rates of AKI (20.0 vs 3.0%; p?<?0.0001), ICU admissions (88.0 vs 25.1%; p?<?0.0001), and hospital LOS (21.9 vs 1.4 days; p?<?0.0001). Of the repeat CT scans, 59.4% demonstrated no significant difference and did not require blood products or the operating room.

Conclusion

Two CT scans performed during blunt trauma encounters demonstrated mixed benefit and were associated with an increased hospital LOS. Additionally, IV contrast was associated with lower rates of AKI.

     

Global and Japanese regional variations in radiologist potential workload for computed tomography and magnetic resonance imaging examinations

Purpose

To investigate the global variation in radiologist potential workload for CT and MRI examinations, and the regional variation in potential workload and extent of radiologists’ involvement in CT and MRI examinations in Japan.

Methods

“Radiologist potential workload” was defined as the annual number of CT plus MRI examinations divided by the total number of diagnostic radiologists. The extent of radiologists’ involvement was measured as the proportion of CT and MRI examinations to which “Added-fees for Radiological Managements on Imaging-studies (ARMIs)” were applied among eligible examinations. Maximum variation was computed as the ratio of the highest-to-lowest values among the countries or Japanese prefectures.

Results

The radiologist potential workload in Japan was 2.78–4.17 times higher than those in other countries. A maximum prefecture-to-prefecture variation was 3.88. The average percentage of CT plus MRI examinations with ARMI applied was 43.3%, with a maximum prefecture-to-prefecture variation of 3.97. Prefectures with more radiologists tended to have a higher extent of radiologists’ involvement.

Conclusions

Japan had a far greater radiologist potential workload compared with other countries, with a large regional variation among prefectures. Prefectures with more radiologists tended to have a higher extent of radiologists’ involvement in CT and MRI examinations.