Objectives & Background With increasing demands on the NHS and also radiology time, we wondered if the EM trauma team leaders were able to accurately assess whether patients required a whole body scan (and thus if we could reduce the health burden of numbers of scans done).
Methods Over a 3 month period from February to May 2015 a simple questionnaire was completed as part of the trauma chart documentation at a major trauma centre in the West Midlands. This was filled in by the trauma team leader (TTL). The TTL was asked to predict if the scan was going to be significantly abnormal and also the main reasons for the scan being done (mechanism/abnormal physiology etc).
Data was collected and collated at the end of the study and tables produced to show High/Low Gestalt and actual outcome.
Significance of injury was decided on the basis of change of treatment or requiring admission under a specialty team other than EM. All trauma scans were eligible and no exclusion criteria were specified.
Results 98 completed forms were able to be used, (of a potential 180).
For the 98 cases where the forms were filled and the patient met our trigger for a trauma team, TTL sensitivity and specificity were calculated.
Sensitivity was 77.42% (58.9% to 90.41%), Specificity was 86.67% (69.28% to 96.24%).
LR (positive test)=5.80 (2.52 to 14.80)
LR (negative test)=0.26 (0.12 to 0.47)
The primary reasons for exclusion were incomplete documentation and trauma scans not being done (patients for whom trauma chart documentation was used but who did not meet the preset criteria).
Conclusion Although TTLs are reasonably accurate when it comes to deciding who should have a full trauma scan we are not sufficiently good (as a group) to determine whether a scan should go ahead on clinical acumen alone. Although disappointing in some ways this should give us further evidence in our discussions with radiology colleagues about the need for a major trauma CT scan.
We are good, but not quite good enough to avoid the scan.
- emergency departments
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