NCEPOD: Trauma - Who Cares? - London Health Programmes

Management of circulationFigure 26. CT scan of the chest, abdomen or pelvis performed300250Number of patients200150100500Yes No Not answeredInvestigation of haemorrhageIt is often the case that an experienced trauma surgeon willidentify patients who need an immediate trauma laparotomysimply by the nature of the trauma and their failure torespond to fl uid therapy. In these cases further investigationmay be unnecessary and delay the time to defi nitive care,which is associated with poorer outcomes.Some patients will require further investigation and optionsinclude DPL, FAST or CT scanning. The availability of theseoptions is described in the organisational chapter. Whilst theuse of DPL is falling as a consequence of better access tomore sophisticated imaging, only one in three emergencydepartments had access to FAST.Use of investigationsClinicians completing the A&E questionnaire indicated that254/495 (51.3%) patients had a CT scan of the chest and/or abdomen and/or pelvis for the assessment of injuries andpotential haemorrhage. For 18 patients this question was notanswered (Figure 26).For the large majority of patients (185/241; 76.8%) thereason given for not scanning the chest, abdomen or pelviswas because it was not clinically indicated. However, 22patients did not have a CT scan as they were considered toounstable to be transferred to the CT scanner. For a furtherthree patients it was indicated that they were taken straightto theatre. There was one case where a scan could not beperformed as the CT scanner was broken.The percentage of patients requiring CT for investigationfor haemorrhage was found to be higher on assessmentof the casenotes (483/795; 60.8%) compared to thatreported in the A&E questionnaire. This was simply becauseof the difference in the returned documentation (513 A&Equestionnaires v 795 sets of casenotes), there were no cases73