• E Peytel, F Menegaux, P Cluzel, O Langeron, P Coriat, and B Riou.
• Département d'anesthésie-réanimation, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 Boulevard de l'Hôpital, 75651 Paris cedex 13, France.
• Intensive Care Med. 2001 Nov 1;27(11):1756-61.

ObjectivesTotal body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study.Design And SettingProspective study of a cohort in a level 1 trauma centre of an university teaching hospital.Patients And Interventions400 patients with severe blunt trauma. Within 30 min of arrival in the hospital, these patients underwent a rapid imaging assessment at the bedside, including chest and pelvic X-ray, and an abdominal ultrasonography. The decision taken for each imaging technique (chest drainage or thoracotomy, pelvic angiography, and laparotomy, respectively) was judged as appropriate or inappropriate.Measurements And ResultsEmergency chest drainage or thoracotomy was performed in 78 cases (78 appropriate), pelvic angiography in 8 cases (5 appropriate) and immediate laparotomy in 48 cases (47 appropriate). Emergency treatment was decided in 108 patients, and the decisions were considered appropriate in 392 (98%, 95% CI: 97%-99%) cases. Three variables (heart rate, systolic arterial pressure and Glasgow Coma Scale) were independent predictors of the need for an emergency decision, but among patients who had none of these criteria, 16% required an emergency decision.ConclusionsA simple and rapid initial imaging assessment enabled appropriate emergency decisions before further imaging assessment was performed. We recommend that every patient with severe blunt trauma receive this initial assessment.

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