Imaging strategies for patients with multiple and/or severe injuries in the resuscitation room: a systematic review and clinical practice guideline update.
Stefan Huber-Wagner, Rainer Braunschweig, Daniela Kildal, Dan Bieler, Barbara Prediger, Miriam Hertwig, Charlotte Kugler, Stefan Reske, Thomas Wurmb, Gerhard Achatz, Benedikt Friemert, Carsten Schoeneberg
Author Information
Stefan Huber-Wagner: Department of Trauma Surgery, Schwäbisch Hall Diakonie Hospital, Schwäbisch Hall, Germany.
Rainer Braunschweig: Institut of Radiology, University Erlangen, Germany, Member of the Board of the Working Group On Musculoskeletal Imaging (AG MSK) of the German Radiological Society, Berlin, Germany.
Daniela Kildal: Department of Radiology, Upper Valais Hospital Centre (Brig), Brig, Switzerland.
Dan Bieler: Department of Orthopaedics and Trauma Surgery, Medical Faculty University Hospital Duesseldorf, Heinrich-Heine-University, Moorenstrasse 5, 40225, Duesseldorf, Germany. dan.bieler@med.uni-duesseldorf.de.
Barbara Prediger: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany.
Miriam Hertwig: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany.
Charlotte Kugler: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany.
Stefan Reske: Department of Radiology, Heinrich Braun Hospital, Zwickau, Germany.
Thomas Wurmb: Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Würzburg University Hospital, Würzburg, Germany.
Gerhard Achatz: Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Bundeswehr Hospital of Ulm, Ulm, Germany.
Benedikt Friemert: Bundeswehr Hospital of Ulm, Ulm, Germany.
Carsten Schoeneberg: Department of Orthopaedics and Trauma Surgery, Alfried Krupp Hospital, Essen, Germany.
PURPOSE: Our aim was to develop new evidence-based and consensus-based recommendations for imaging strategies in patients with multiple and/or severe injuries in the resuscitation room. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. METHODS: MEDLINE and Embase were systematically searched to August 2021. INCLUSION CRITERIA: patients with multiple and/or severe injuries in the resuscitation room, randomised controlled trials, prospective cohort studies, cross-sectional studies, and comparative registry studies; comparison of interventions for imaging strategies; patient-relevant clinical outcomes such as diagnostic test accuracy and mortality. Further literature reports were obtained from clinical experts. We considered patient-relevant clinical outcomes such as diagnostic test accuracy and mortality. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. RESULTS: Twenty-one studies with a total of 55,227 patients were identified. There were studies with low risk (n = 2), high risk (n = 5) and unclear risk of bias (n = 14). Relevant topics were sonographic imaging of the chest and abdomen (n = 8 studies), X-ray of the chest (n = 1), indications for whole-body computed tomography (n = 6), CT scanner location (n = 1), whole-body computed tomography in haemodynamically unstable patients (n = 3), and prehospital sonography (n = 2). There were studies with low risk (n = 2), high risk (n = 5) and unclear risk of bias (n = 14). One new recommendation was developed, six were modified. All achieved strong consensus. CONCLUSION: While extended focused assessment with sonography for trauma should be performed for diagnostic purposes after blunt and/or penetrating thoracic and/or abdominal trauma as part of the primary survey in the resuscitation room, whole-body computed tomography (WBCT) gains highest importance as part of the diagnostic procedures for severely injured patients. WBCT with a trauma-specific protocol must be performed in a timely manner if the patient does not require an immediate intervention. Magnetic resonance imaging can be indicated as a further primary diagnostic tool for specific conditions. Two studies were judged to be of low risk of bias in all domains. The risk of selection bias was high in two studies and unclear in seven studies.
