Trauma Computed Tomography: Benefits and Hazards
Shahram Paydar
0
1
2
Behnam Dalfardi
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1
2
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B. Dalfardi (&) Student Research Committee, Shiraz University of Medical Sciences
, Shiraz,
Iran
1
S. Paydar Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences
, Shiraz,
Iran
2
S. Paydar Department of General Surgery, Shiraz University of Medical Sciences
, Shiraz,
Iran
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To the Editor,
With much interest and attention, we read the paper of
Sierink et al. [1] in the April 2014 issue of the World
Journal of Surgery. In that article, based on the study
resultsi.e., lower 30-day mortality rate among patients
who underwent immediate total-body computed
tomography (TBCT) compared with those evaluated with
conventional imaging followed by selective CT scansthe
authors defended the role of immediate TBCT in the acute
trauma care setting. It seems fair to note some points.
Despite its advantage, the routine use of immediate TBCT
to evaluate trauma patients can expose them to unnecessary
doses of radiation, consequently putting them at a probable
increased risk of cancer [2]. Another major concern associated
with contrast-enhanced CT is contrast-induced nephropathy, a
main cause of hospital-acquired acute renal injury [3].
From the aspect of the time used to assess the patients, the
authors criticized the use of X-ray imaging in trauma cases.
However, it should be noted that selective use of
conventional cervical, chest, or pelvic imaging instead of routine
radiography for all patients can be significantly time saving
[4, 5]. In this respect, a review of the literature turned up
several articles regarding efforts made to develop some
criteria for the use of selective radiography in trauma cases.
Transferring trauma patients between the admission ward
and the CT room is yet another difficulty associated with the
routine use of immediate TBCT in these cases. In addition,
such an approach can increase health care costs for the patients
and can lead to an increase in the costs associated with the use
of technical personnel and those that result from the inevitable
wear and tear of the equipment. Another negative point is that
long-term use of routine immediate TBCT probably affects
the quality of surgeons skills in history taking and physical
examination of trauma patients. It also may lead to findings of
questionable clinical importance [4, 5].
Finally, it should be remembered that CT is not available in
all regions of the world. Also, in conditions such as a disaster,
the increased number of trauma patients can affect the
availability of the use of CT. Therefore, the need for alternative
approaches in the acute trauma care setting is still present.
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