• Thomas Mistral, Vivien Brenckmann, Laurence Sanders, Jean-Luc Bosson, Gilbert Ferretti, Frederic Thony, Samuel M Galvagno, Jean-François Payen, and Pierre Bouzat.
• From the Grenoble Alpes Trauma Center, Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France (T.M., J-F.P., P.B.); Université Grenoble Alpes, Grenoble, France (T.M., V.B., J-L.B., G.F., J-F.P., P.B.); INSERM U1216, Grenoble, France (T.M., J-F.P., P.B.); Département de Médecine d'Urgence, CHU Grenoble Alpes, Grenoble, France (V.B., L.S.); Pôle Recherche, CHU Grenoble Alpes, Grenoble, France (J-L.B.); Pole Imagerie, CHU Grenoble Alpes, Grenoble, France (G.F., F.T.); Divisions of Trauma Anesthesiology and Critical Care Medicine, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, Maryland (S.M.G.).
• Anesthesiology. 2017 Jun 1; 126 (6): 1116-1124.

BackgroundThe purpose of this study was to test the diagnostic performance of clinical judgment for the prediction of a significant injury with whole-body computed tomography scanning after high-energy trauma.MethodsThe authors conducted an observational prospective study in a single level-I trauma center. Adult patients were included if they had an isolated high-energy injury. Senior trauma leaders were asked to make a clinical judgment regarding the likelihood of a significant injury before performance of a whole-body computed tomography scan. Clinical judgments were recorded using a probability diagnosis scale. The primary endpoint was the diagnosis of a serious-to-critical lesion on the whole-body computed tomography scan. Diagnostic performance was assessed using receiver operating characteristic analysis.ResultsOf the 354 included patients, 127 patients (36%) had at least one injury classified as abbreviated injury score greater than or equal to 3. The area under the receiver operating characteristic curve of the clinical judgment to predict a serious-to-critical lesion was 0.70 (95% CI, 0.64 to 0.75%). The sensitivity of the clinical judgment was 82% (95% CI, 74 to 88%), and the specificity was 49% (95% CI, 42 to 55%). No patient with a strict negative clinical examination had a severe lesion (n = 19 patients). The sensitivity of the clinical examination was 100% (95% CI, 97 to 100%) and its specificity was 8% (95% CI, 5 to 13%).ConclusionsClinical judgment alone is not sufficient to reduce whole-body computed tomography scan use. In patients with a strictly normal physical examination, whole-body computed tomography scanning might be avoided, but this result deserves additional study in larger and more diverse populations of trauma patients.

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