Studies explore strategies for emergency room MSCT

Although multislice CT is now a routine part of the primary survey, many emergency departments have not fully explored an efficient patient management protocol. German researchers have produced encouraging results with a "structured" diagnostic and treatment process conducted by a trauma team comprising radiologists, trauma surgeons, and dedicated personnel.

Investigators at Julius-Maximilian University Hospital in Wurzburg, Germany, devised an innovative turntable and slide mechanism that allows for diagnostic procedures and damage control surgery without patient transfer or rearrangement (Anaesthesist 2004;53[7]:645-650). Trauma patients first receive a primary survey, anesthetic management, and ultrasound exam. Following a turn of the table, they undergo conventional x-rays. Tracks for the slide enable immediate transfer to a CT scanner, and the table is then moved back to its first position for surgery.

Another German research team, at Ludwig-Maximilian University Hospital in Munich, determined that complete diagnostic imaging with MSCT can be performed within 30 minutes after trauma room admission (Unfallchirurg 2004;107[10]:937-944). The entire contrast-enhanced MSCT study, including pilot scan and contrast administration, required six minutes. Multiplanar reconstruction of the spine and bony pelvis took about 12 minutes.

In another study, the same Munich researchers evaluated workflow in a series of 315 consecutive patients using three algorithms:

- a stand-alone MSCT scanner with preparation room;

- three centralized MSCT scanners with preparation room and radiology nurses; and

- a stand-alone, single-slice CT scanner without preparation room or nurses.

They found no significant difference in study time for mobile patients on any logistic model. The time required to examine immobile patients was significantly less with MSCT than with single-slice CT, but the time needed to prepare, transfer, and provide aftercare for this population did not differ substantially. Dr. Ulrich Linsenmaier presented the study findings at the 2004 RSNA meeting.

"MSCT represents the main diagnostic tool in our ER algorithm," said coauthor Dr. Markus Korner. "We strongly encourage abandoning any conventional radiological studies other than focused abdominal ultrasound and one initial chest x-ray in intubated patients."