Comparison of clinical findings and whole body tomography results in multiple trauma patients coming to the emergency department

Trauma is one of the important causes of young age deaths all over the world. At the same time, disability and economic losses it causes are an important public health problem. The evaluation, diagnosis and treatment of patients who are injured due to trauma are performed according to the principles of Advanced Trauma Life Support (ATLS). Timing is very important in trauma patients and requires a systematic approach. Whole-body computed tomography (WBCT) has gained popularity over selective imaging, since computed tomography (CT) provides faster, detailed clinical information and becomes available. Organ and tissue damage can be detected quickly and in detail with emergency WBCT in trauma patients and further treatment planning can be clarified quickly. Algorithms accepted worldwide to decide WBCT have not been created yet. There are studies advocating that trauma mechanism and physical examination alone are weak in defining injuries in patients with multiple trauma, according to the Injury Severity Scores or in the presence of serious trauma involving two or more body regions, WBCT screening should be performed at the discretion of the emergency physician.The aim of our study is to evaluate the accuracy of the suspicion of clinical injury by comparing the demographic features, injury mechanism and severity, examination and laboratory findings of the multiple trauma patients admitted to Afyonkarahisar Health Sciences University (AFSU) Medical Faculty Hospital and to examine the necessity of the whole body computed tomography and its effect on discharge. Patients from all age groups who applied to AFSU Medical Faculty Emergency Department between 01.09.2017 and 01.09.2018 due to multiple trauma and who were screened for WBCT were included in our study. Pregnant, isolated, penetrating traumas, patients whose information is not available in the hospital data system and patient file, and patients who had tomography scan in another healthcare institution and transferred to our clinic were excluded from the study. Before starting the study, approval was received from the AFSU Clinical Research Ethics Committee. The data of the patients included in the study were obtained using the hospital data system and emergency files. Age, gender, time of application, type and severity of trauma, physical examination findings, blood examination results, direct radiography, FAST, CT findings, consultation requests, hospitalization and discharge status, and death information were recorded. The collected data was transferred to the SPSS 23 (Statistical Package for the Social Sciences) program. In statistical evaluation, descriptive features of the data were obtained with percentage, average and standard deviation. Relations between categorical variables were examined by Pearson's Chi-square analysis or Fisher's exact test / Monte Carlo analysis. Logistic regression analysis was used to determine the parameters that affect patients' hospitalization status. A total of 601 patients, 412 (68.6%) of whom were male, were included in our study. It was observed that the patients were in the 8-44 age group with a rate of 47.6% (n = 286). Motor vehicle accidents were the most common in trauma etiology with a rate of 81.6% (n = 490). Considering the physical examination findings; In head and neck examination, in 56.2% (n = 338) head trauma findings were not found, and the most common finding was 29.5% (n = 177) scalp hematoma. In 81.4% (n = 489) there was no findings in cranial CT findings; The most common finding was 6.8% (n = 41) intracranial hemorrhage. A significant relationship was detected between vertebral examination findings and vertebral CT findings (p <.001). There was no trauma finding in the thorax examination at the rate of 75.4% (n = 453), the most common finding was rib fracture examination finding at the rate of 15.1% (n = 91), in thorax CT findings, there was no finding in 74.2% (n = 446); The most common finding was 8% (n = 48) multiple rib fractures. According to abdominal examination findings, there was no findings in 83.9% (n = 504); the most frequent finding was 11% (n = 31) defense-rebaund. According to abdominal CT findings in 90.7% (n = 545) findings were absent, and the most common finding was 8.5% (n = 51) solid organ injuries. Patients whose ALT-AST and Amylase values were not within the normal range were found to have significantly higher rates of solid organ injury than patients with normal limits (p <.001). In pelvic examination, 96.0% (n = 577) findings were not detected and 93.2% (n = 560) findings were not found according to pelvic CT. It was observed that 42.1% (n = 253) of the patients were hospitalized and 30.4% (n = 77) were transferred to the intensive care unit. It was found that hemodynamically unstable status, abdominal examination findings, WBC value, PLT value, AST value, cranial CT findings, thoracic CT findings and thorax CT findings were affected upon hospitalization. As a result, in our study, we found a statistically significant relationship between GKS, vital parameters, ALT-AST-Amylase values, physical examination findings, and WBCT results . Although WBCT is a very useful diagnostic method, we think that it should not replace physical examination, emergency physicians should make a WBCT decision in line with the clinical findings obtained by evaluating trauma patients in detail, and thus, the number of unnecessary screenings can be reduced.