Assessment of RAdiopaque Patient IDentification Stickers (RAPIDS) for patient-scan correlation in a mass casualty incident.

PURPOSE: To qualitatively assess the legibility of radiopaque patient identification stickers and their effect on image quality. These stickers are intended for use as a part of a patient registration and identification pack utilized in a mass casualty incident (MCI), to prevent errors in correlating patients with their diagnostic imaging and reports. METHODS: Four different prototype designs of stickers with radiopaque identification numbers which are legible on radiographs and CT were created. These were affixed to head and thorax phantoms and scanned using standard imaging protocols. Images were reviewed qualitatively for legibility and the presence of image degradation due to the radiopaque sticker materials using Likert scales by four radiologists and four emergency physicians. RESULTS: All four prototypes were confidently legible on forehead, shoulder and sternum on CT on topogram and reconstructed images. Sticker positioning over the temple resulted in unreliable legibility on topogram. All prototypes were confidently legible on shoulder and sternum on CT and radiographs. Significant image degradation was reported on radiographs with sticker position over the sternum. The preferred anatomic position was the forehead. CONCLUSION: In a mass casualty incident, radiopaque patient identification stickers affixed to injured patients may help to ensure confidence in the correlation between patients and their imaging. Tested prototypes were found to be easily legible without substantial degradation of image quality. Preferred anatomical position and construction material was established. Consideration should be given to addition of such radiographic identity aides to MCI patient registration packs.

Splenic trauma and salvage.

The traditional view of the spleen as an expendable organ is no longer tenable. In recent years the importance of the spleen in immunologic processes of bacterial clearance, phagocytosis, and antibody formation has been well established. Post-splenectomy sepsis, once only considered a threat in children, is now recognized in adults. Several techniques have evolved since the early 1930s in dealing with splenic injury. These techniques include observation, prevention of iatrogenic injury, auto transplantation, and suture repair in conjunction with hemostatic agents. A recent review of splenectomies done at our institution showed a salvage rate of 97 per cent in children and 6.3 per cent in adults. The preservation of splenic function should be the principal goal in the isolated injury to the spleen; especially for iatrogenic trauma, conservative surgical management is indicated, particularly in children, but also now in adults.