Journal Club
January 2010 Emergency Medicine Journal Club Vignette

During a recent busy ED shift, a Level II trauma patient comes in. The patient is a 25 year old unrestrained driver involved in a head on collision. There was loss of consciousness and the patient is amnestic to the event. The patient is slightly confused with a GCS of 14 and is only complaining of head and neck pain. On exam, the patient has no evidence of head trauma but does have C5-C7 tenderness. The rest of the exam is unremarkable. The trauma chief resident wants to obtain a CT of the head, neck, chest, abdomen, and pelvis with spinal reconstructions. While you agree that the patient needs a CT of the head and neck due to the history and exam, you do not agree with the other imaging, yet you are not certain of the current literature supporting or refuting such an approach.

You decide to investigate this for yourself and explore the following approach:

PICO Question

Population: Blunt trauma patients with normal exam
Intervention: Use of Pan CT
Comparison: Selective CT use
Outcome: Diagnostic Test Characteristics, Improved Outcomes (Change in treatment plan/disposition)


Search Strategy: Pubmed; Keywords: trauma AND computed tomography AND blunt AND abdominal.
Limits: English, Last 5 years, adults. 222 citations found, of which the following three are selected after abstract review:
First years: Whole body imaging in blunt multisystem trauma patients without obvious signs of injury. Arch Surg 2006; 141: 468-475.

Article critique
Second years: Routine versus selective computed tomography of the abdomen, pelvis, and lumbar spine in blunt trauma: a prospective evaluation. Journal of Trauma 2009; 66: 1108-1117.

Article critique
Third years: Clinical prediction rules for identifying adults at very low risk for intra- abdominal injuries after blunt trauma. Annals of Emerg Med 2009; 54: 575-584.

Article critique
1st and 2nd years use the "Diagnosis Critical Review Form" (Download)
3rd years use the "Clinical Decision Critical Review Form" (Download)


Extra Articles: Routine versus selective multidetector-row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management. J Trauma. 2009 Nov;67(5):1080-6.
Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 2009 Oct;67(4):779-87.
© Ohio State University Department of Emergency Medicine