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An evidence based blunt trauma protocol
  1. Raoul van Vugt1,
  2. Digna R Kool2,
  3. Satish F K Lubeek3,
  4. Helena M Dekker2,
  5. Monique Brink2,
  6. Jaap Deunk1,
  7. Michael J R Edwards1
  1. 1Department of Surgery, Division of trauma surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Radboud University Nijmegen, Faculty of Medical Sciences, Nijmegen, The Netherlands
  1. Correspondence to Dr Raoul van Vugt, Radboud University Nijmegen Medical Centre, Internal postal code 690, Geert Groote Plein 10, Nijmegen 6500 HB, The Netherlands; raoul.vanvugt{at}


Objective Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this study's aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt high-energy trauma patients, especially for the use of CT.

Methods An evidence-based flow chart was created with criteria based on trauma mechanism, physical examination and laboratory analyses to indicate appropriateness of conventional radiography (CR), sonography and CT of head, cervical spine and trunk. To evaluate this protocol, the authors prospectively included 81 consecutive patients. Collected data included protocol adherence and number and type of performed CR and CT scans. The authors also determined the time needed to perform radiological investigations, adverse events in the CT room and clinically relevant missed injuries after 1-month clinical follow-up.

Results There was 99% adherence to the protocol concerning CT. Seventy-nine patients (98%) received one or more CT scans: 72 (89%) had thoracoabdominal, 78 (96%) cervical spine and 54 (67%) had cranial CT. In 30 patients, one or more CT scans of body regions could be omitted. In 38%, CR was wrongly omitted or performed incorrectly at a variance with the protocol. No major adverse events occurred in the CT room and no clinically relevant injuries were missed.

Conclusions The authors introduced a diagnostic protocol that seems feasible and safe for the evaluation of adult blunt high-energy trauma patients. Implementation of this protocol has the potential to reduce unnecessary radiological investigations, especially CT scans.

  • Tomography
  • x-ray computed
  • resuscitation
  • protocol
  • wounds and injuries
  • trauma
  • imaging
  • CT/MRI

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  • An appendix is published online only. To view this file please visit the journal online (

  • Competing interest None.

  • Patient consent Since the included patients were treated according to common practice and this study was considered an observational study, the medical ethical board waived the need for informed consent.

  • Ethics approval The ethics approval was provided by the local ethical committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.