Comparing diagnostic findings and cost of whole body computed tomography to traditional diagnostic imaging in polytrauma patients.

OBJECTIVE: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT. DESIGN: Prospective, observational study. SETTING: Private, level 1 veterinary trauma center. ANIMALS: Convenience sample of 21 client-owned cats and dogs presenting with polytrauma. INTERVENTIONS: Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist. MEASUREMENTS AND MAIN RESULTS: Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001). CONCLUSIONS: Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.

Utilization of whole body computed tomography in polytrauma patients.

OBJECTIVE: To determine the safety, feasibility, and utility of whole body computed tomography (WBCT) in polytrauma patients. A second objective was to describe the utilization of the VetMouse Trap for sedated WBCT in polytrauma patients. METHODS: A prospective, observational study in a high-volume private practice. Any cat or dog weighing <20 kg that presented to the emergency department following a polytrauma was eligible. Patients were given analgesia and sedation prior to placement in the VetMouse Trap. A WBCT was then performed. RESULTS: A total of 16 patients (8 dogs and 8 cats) met inclusion criteria. All patients presented with blunt trauma; 3 also had evidence of penetrating wounds. Five (31.25%) patients met inclusion criteria for WBCT based on their neurological evaluation. Five (31.5%) were non-ambulatory with suspicion of orthopedic injury, and 37.5% met additional criteria for WBCT. The most common areas of injury were head (43.7%), lungs (25%), and pelvis (25%). Four patients (25%) had evidence of cavitary effusion that was not seen on focused assessment using sonography for trauma (FAST) scan. No patient had any adverse events during the CT. CONCLUSION: This study demonstrated successful WBCT imaging of the sedated small animal polytrauma patient with the VetMouse Trap.