Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada.
Department of Surgery, 8167Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Can Assoc Radiol J. 2021 May;72(2):293-310. doi: 10.1177/0846537120914247. Epub 2020 Apr 8.
Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.
现代医学成像技术的进步，加上复杂的创伤复苏策略，以及高度组织化的区域性创伤系统，已经在严重创伤患者的治疗中带来了范式转变。尽管立即进行探索性手术以识别和控制危及生命的损伤仍然有其作用，但加速的图像采集和解释程序现在使得主要中心的创伤外科医生很少在没有计算机断层扫描（CT）或其他成像的情况下进行损伤控制性手术，尤其是在钝性创伤的情况下。事实上，由于与主要机制创伤相关的临床上隐匿性损伤的高发生率，甚至在虚弱或老年患者中较低能量的创伤，CT 成像已经变得像体格检查一样不可或缺，如果不是更重要的话，在支持最佳结果的关键决策中。特别是，在对重大创伤进行初步评估后立即进行全身 CT（WBCT）检查，可以快速、全面地检查损伤情况，从而更好地进行手术规划，避免多次后续检查的需要，并在需要时进行专门的重建。对于那些在轻微创伤后有隐匿性损伤风险的患者，WBCT 有助于更安全的出院计划和简化的随访。通过标准化指南、简化的协议、综合报告、可访问的网络平台以及与临床医生的积极合作，专门从事创伤和急诊成像的放射科医生能够更好地理解高风险患者的复杂损伤，从而做出更优的临床决策。虽然陈旧的教条长期以来一直警告说，CT 扫描仪是处理挑战性创伤患者的最后一个地方，但现代实践表明，早期全面成像通常可以安全有效地进行，并且符合患者的最佳利益。本文概述了近年来主要创伤的诊断成像角色发生了怎样的显著变化。
