An evaluation of the use of whole-body computed tomography in trauma patients at a United Kingdom trauma centre Kuhan Venugopal a , Alison F. Kinghorn a , Curtis E. Emordi a , Paul R. Atkinson a,b and Richard J. Kendall a We sought to identify the impact of whole-body computed tomography (WBCT) on working and suspected diagnoses in Emergency Department (ED) trauma patients and to determine the rate of WBCT scans with no detectable traumatic injuries. We performed a retrospective database analysis of all trauma patients who underwent WBCT in 2009, comparing pretest suspicion of specific injury to WBCT findings, looking for the rates of unexpected findings and the absence of traumatic injury in WBCT studies. Our results showed that of the 179 patients who underwent WBCT, no traumatic injury reported in 17 patients while 162 patients demonstrated pathology (47 confirming previously suspected or diagnosed injury and 115 with previously unexpected injury). Overall, WBCT results differed from clinical findings in 130 (72.6%) patients, a statistically significant difference (P < 0.0001). In conclusion, WBCT identifies previously unexpected injuries in almost 66% of ED trauma patients, supporting its continued use in the initial assessment of trauma patients. European Journal of Emergency Medicine 19:193–195  c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Emergency Medicine 2012, 19:193–195 Keywords: emergency service, hospital, tomography scanners, trauma, whole-body imaging, X-ray computed a Emergency Department, Addenbrooke’s Hospital, Cambridge, UK and b Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada Correspondence to Dr Richard J. Kendall, MBBS, Consultant in Emergency Medicine, Emergency Department, Addenbrooke’s Hospital, Cambridge, UK Tel: +44 1223 586594; fax: +44 1223 217057; e-mail: richard.kendall@addenbrookes.nhs.uk Received 19 May 2011 Accepted 12 July 2011 Introduction The use of whole-body computed tomography (WBCT) scans in trauma settings is a relatively new development, made feasible by massive reductions in scan times. Rather than performing localized scans, limited to the regions of the body where injury is suspected, the WBCT in trauma entails computed tomographic (CT) examination of the head, neck, chest, abdomen and pelvis. Several studies have supported the use of CT in trauma by showing significant benefits in terms of patient survival [1] and changes to clinical management [2]. Despite the proven benefit, there remains concern around the significantly increased radiation exposure for trauma patients. There has been debate in the literature as to what might be an appropriate threshold or level of suspicion for undetected underlying injury when per- forming WBCT scans in trauma [2–4]. Addenbrooke’s Hospital Emergency Department (ED) recently adopted the WBCT approach for trauma pati- ents. Owing to the absence of clear national guidelines, clinical judgement of the attending emergency physician or trauma team leader remains the main determinant for selection of trauma patients for WBCT scanning. WBCT exposes patients to high doses of radiation [5], which can be detrimental to health, especially in young patients. The primary aims of this service evaluation were to determine the proportion of WBCT scans that led to the diagnosis of previously unsuspected injuries in trauma patients and to assess how many WBCT scans were being reported as not having a traumatic injury, thus analysing the benefits and risks of this approach. This study was designed to assess traumatic injuries only and did not look into other incidental findings that may or may not have been reported. Methods We performed a retrospective database analysis as a service evaluation, by examining records of all trauma patients who underwent WBCT as part of their initial trauma assessment in the ED at a UK trauma centre during a 12-month period between 1 January and 31 December 2009. The Addenbrooke’s Hospital Picture Archiving and Communication System (PACS) and the Trauma Audit and Research Network (TARN) were used to identify trauma patients who received WBCT scans within this time frame. Scans with no traumatic injury/ injuries were defined as scans where no radiological abnormality associated with trauma was identified by the reporting radiologist. Injuries suspected at the initial resuscitation and documented on the CT request were then compared with actual traumatic injuries identified by the reporting radiologist. We compared pretest suspicion of specific injury with CT findings, to identify the rate of unexpected findings and the number of studies suggesting the absence of traumatic injuries. Data were Short report 193 0969-9546  c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEJ.0b013e32834ada14 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.