[In-hospitaltraumamanagement - trauma suite diagnostics]

Abstract

Whole-body CT is considered gold standard for diagnosis of the multiple injured patient in the trauma suite. So far, no guidelines exist concerning its indication. The trauma team (Trauma Surgery/Visceral Surgery, Anaesthesiology, Radiology) should use standardized triage-criteria for the indication of whole-body CT. The radiologist is responsible for its individual planning, taking clinical and morphological imaging results into consideration, embedding its implementation between assessment and treatment stage. Fast image analysis by an experienced radiologist (specialist or at least 3 years professional experience) as well as interdisciplinary discussion of all findings is essential. The increased importance of endovascular minimally invasive therapy strategies in the treatment of active bleeding or laceration of solid organs may require the consultation of an interventional radiologist as part of the extended trauma team. In addition to CT, a modern trauma suite should be equipped with conventional x-rays and ultrasound in order to comply with a conventional algorithm consisting of sonography, plain film radiography and region specific CT for diagnosis of less severely injured patients. In children, specific attention must be paid to radiation protection. In these cases, modalities without radiation exposure (ultrasound, MRI) play a major role. Detecting all relevant injuries and evolving a therapy strategy in compliance with aspects of radiation protection (ALARA-principle) and legal guidelines (justifiying indication) during the 'golden hour of shock' should be the aim.