Trauma Imaging - Dr. Gibbs

For Cranial Imaging:

1. The GCS is an important component of the decision-making. All patients with a persistent GCS <15 in the setting of blunt trauma should undergo head CT.
2. The New Orleans rule was designed to detect [+] head CTs and the Canadian rule was designed to detect CNS lesions requiring intervention. As such, the Canadian rule has a much higher specificity.
3. There is currently not a clinical decision rule to help guide neuroimaging in patients who are anticoagulated. Very low threshold for imaging in this population
   

For Cervical Imaging:

1. The NEXUS rule is a bit easier to apply at the bedside because mechanism of injury severity information is not needed. The Canadian rule is more specific.
2. NEXUS is applicable in the elderly and has high sensitivity. In patients >65 years it is important to remember that: (a) important cervical injuries result from ground level falls, (b) cervical injuries of the upper spine [C1C2] predominate.
3. In general, NEXUS should not applied in children <8 was there were very few fractures in this cohort (n = 4) and no fractures in children <4 years.

For Chest Imaging:

1. The NEXUS Chest Rule was unveiled at SAEM this year in abstract form. More to follow and too early for prime time.
2. A “normal” chest X-ray provides a tremendous amount of information. While some injuries may be revealed on CT (e.g.: small pneumothoraces, rib fractures), the incidence of clinically important chest injuries in asymptomatic patients is remote.
3. Be sparing with the use of chest CT in patients who:  have a relatively non-concerning chest exam + a negative chest X-ray

Tension on CT. Hmmm.

For Abdominal Injury:

1. No adult CDR is out there. PECARN recently developed a pediatric rule (Annals last month).
2. Recall that bowel injuries  may be missed on abdominal CT. The most important (and common) CT finding in these patients = free fluid with no solid organ injury.
3. Diaphragm injuries can also missed or these may be mistaken for LLL effusions, contusions. Always consider diaphragm injury with LLL findings on chest X-ray in patients with the right mechanism.