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Selected Works of Adam Sigal, MD
Article
Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?
Reading Hospital General Surgery Residency
  • Shannon Foster, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Alison Muller, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Jeremy Conklin, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Vicente Cortes, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Forrest B Fernandez, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Thomas A Geng, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Eugene Francis Reilly, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Adam Sigal, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
  • Adrian Ong, Reading Trauma Center, Reading Hospital-Tower Health, West Reading, PA,
Link
Document Type
Article
Publication Date
10-1-2019
Disciplines
Abstract

BACKGROUND: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients.

METHODS: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as "low index" or "more than a low index". The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated.

RESULTS: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis).

CONCLUSION: Clinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary.

SUMMARY: For awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.

Citation Information
Shannon Foster, Alison Muller, Jeremy Conklin, Vicente Cortes, et al.. "Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?" Vol. 218 Iss. 4 (2019) p. 755 - 759
Available at: http://works.bepress.com/adam-sigal/14/