Critical Care Medicine  |   June 2017
Clinical Judgment Is Not Reliable for Reducing Whole-body Computed Tomography Scanning after Isolated High-energy Blunt Trauma
Author Notes
  • 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.).
  • T.M. and V.B. contributed equally to this article.
    T.M. and V.B. contributed equally to this article.×
  • Submitted for publication September 19, 2016. Accepted for publication February 17, 2017.
    Submitted for publication September 19, 2016. Accepted for publication February 17, 2017.×
  • Address correspondence to Dr. Bouzat: Pôle d’Anesthésie-Réanimation, CHU Grenoble Alpes, F-38000 Grenoble, France. PBouzat@chu-grenoble.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Clinical Science / Critical Care / Radiological and Other Imaging / Technology / Equipment / Monitoring / Trauma / Burn Care
Critical Care Medicine   |   June 2017
Clinical Judgment Is Not Reliable for Reducing Whole-body Computed Tomography Scanning after Isolated High-energy Blunt Trauma
Anesthesiology 6 2017, Vol.126, 1116-1124. doi:10.1097/ALN.0000000000001617
Anesthesiology 6 2017, Vol.126, 1116-1124. doi:10.1097/ALN.0000000000001617
Abstract

Background: The 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.

Methods: The 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.

Results: Of 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%).

Conclusions: Clinical 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.