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. 2021 May;190(2):799-805.
doi: 10.1007/s11845-020-02351-y. Epub 2020 Sep 4.

Severe thoracic or abdominal injury in major trauma patients can safely be ruled out by "Valutazione Integrata Bed Side" evaluation without total body CT scan

Giannazzo Giuseppe  1 , Melara Ilaria  2 , D'Argenzio Federico  3 , Coppa Alessandro  4 , Gualtieri Simona  5 , Peiman Nazerian  1 , Bartolini Marco  6 , Grifoni Stefano  1
Affiliations

Severe thoracic or abdominal injury in major trauma patients can safely be ruled out by "Valutazione Integrata Bed Side" evaluation without total body CT scan

Giannazzo Giuseppe et al. Ir J Med Sci. 2021 May.

Abstract

Background: During the initial assessment of trauma patients, the severity of injury is very often not immediately recognizable. In trauma centers, a total body CT (TBCT) scan is routinely used to evaluate this kind of patients, even if it is burdened with health risk, economical costs, and logistical difficulties.

Aim: We investigated the use of a clinical guide to establish a safe alternative to this routine practice.

Methods: We enrolled retrospectively 438 patients referring to the Emergency Department of Careggi University Hospital in Florence (Italy) over a 1-year period from 2014 to 2015, with the evidence of trauma and high-priority triage codes and then subjected to TBCT. We created a tool called VIBS ("Valutazione Integrata Bed Side") (from the Italian translation of "Bed Side Integrated Evaluation") which included all clinical, laboratory, and diagnostic data acquired bedside during the primary survey. Every VIBS profile was dichotomized in negative or positive if there was at least one altered item. We performed an analysis of correlation between VIBS and TBCT to determine sensibility, specificity, positive, and negative predictive value and likelihood ratio of VIBS.

Results: Sensibility of VIBS in the prediction of positive CT scan was 100% and specificity was 31.7%. Positive and negative predictive value (95% C.I.) was 44.3 (38.8-49.5) and 100 (94.0-99.9). Positive and negative likelihood ratios were 1.464 and 0. Failure rate resulted in 0% and efficiency was 20.54%.

Conclusions: VIBS can safely rule out severe thoracic or abdominal injuries. This approach could limit the use of TBCT in one-fifth of suspected major trauma patients.

Keywords: Extended FAST; Total body CT scan; Trauma; Traumatic injuries; Ultrasound.

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Comment in

  • To scan or not to scan trauma patients, that is the question.
    Lorenzati B, Giamello J, Tortore A, Allione A, Barutta L, Bernardi E, Blangetti I, Bono A, Galaverna R, Grosso A, Maggio E, Martini G, Peloponneso V, Perotto M, Ramonda P, Rega M, Sciolla A, Lauria G. Lorenzati B, et al. Ir J Med Sci. 2022 Jun;191(3):1451-1452. doi: 10.1007/s11845-021-02692-2. Epub 2021 Jun 22. Ir J Med Sci. 2022. PMID: 34156662 No abstract available.

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