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Table 1 Precautionary rule for CT interpretation by emergency physicians in blunt trauma

From: Establishment and implementation of an effective rule for the interpretation of computed tomography scans by emergency physicians in blunt trauma

Caution #1  Unstable physiological condition
           1> GCS < 10 points
           2> Systolic pressure < 90 mmHg
  #2  Suspected injury to multiple regions of the body
           1> severe pain in more than 2 of the 6 regions (head, face, neck, chest, abdomen, pelvis)
           2> bleeding, wounds, deformities, or contusions in more than 2 of the 6 regions
  #3  Injury due to high energy mechanism
           1> traffic accident:
          pedestrian, bicycle vs. vehicle, motorcycle crash, highway crash
          victim thrown from vehicle, death of fellow passenger
          case involving a difficult rescue, sideslip of the vehicle, etc.
           2> fall (3 m)
           3> crushed under heavy object
           4> other high energy mechanisms
  #4  Case that requires invasive emergency treatment necessitating movement to other rooms
           1> case that requires an emergency operation
           2> case that requires emergency angiography (embolization)
           3> other invasive treatment required
Action If patient‘s condition agrees to one of above criteria at least, EP should take action as follows
           1) EP should actively employ enhanced CT for chest, abdomen and pelvis if possible.
           2) EP should re-interpret emergency CT more than twice after a short interval.
           3) EP should change window level according to organs to interpret.
           4) EP should evaluate not only in an axial view but also in a sagittal view or coronal view if needed.
           5) EP should actively evaluate bone injuries using three-dimensional view.
           6) EP should repeat CT after time has passed if there are unclear points.
Additional advice If there problems as follows, EP should consider real-time consultation with a radiologist
           1) Patient’s physiological condition deteriorates in spite of treatments.
           2) Data of laboratory findings show development of anemia or metabolic acidosis in spite of treatments.
           3) Unclear points remain in spite of re-interpretation CT or repetition of CT.
  1. We established a new precautionary rule for the interpretation of emergency CT scans in cases of blunt trauma.