The level of evaluation of acute trauma pathologies by the emergency medicine assistant of abdominal tomography images taken in trauma patients

Introduction and Aim: Trauma-related injuries are among the most common causes of admission to the emergency department. Abdominal injury ranks third among the causes of death due to trauma, after head, neck and chest injuries. Computed tomography (CT) is the most accurate nonsurgical diagnosis of the degree and anatomy of the injury in trauma patients. CT reliably shows the amount of bleeding, intraperitoneal and extraperitoneal injuries, and solid organ injuries. Therefore, CT is an important diagnostic tool for solid organs both in diagnosis and follow-up. CT is also useful in demonstrating pelvic and spinal fractures. Accurate interpretation and clinical association of such an important imaging method by the emergency medicine assistant (ATA) is life-saving. In our study, we aimed to investigate the level of evaluation of acute trauma pathologies by ATA in abdominal CT images taken from trauma patients. Materials and methods: Contrast-enhanced abdominal CT images of 207 patients admitted with trauma between 15.12.2020 and 15.12.2021 were included in this study. Trauma patients who underwent non-contrast abdominal CT and patients over 90 years of age were not included in our study. An ATA who had completed three years and completed a radiology rotation was selected to evaluate the images of the patients. Contrast-enhanced abdominal CT was evaluated by ATA and compared with the radiology official report. The correct diagnosis rate of ATA was examined. Written informed consent was obtained from the patients/relatives evaluated within the scope of the study by informing them about the subject of the study. The PACS (Picture Archiving and Communication Systems) system in the emergency department was used for abdominal CT images of ATA patients. The radiology report was followed from the Nucleus hospital information management system. The radiologist and ATA who prepared the radiology report were not aware of each other's evaluations. The radiologist's report was accepted as the gold standard. In addition, patients' age, gender, current complaints, symptoms, trauma classification ( in-vehicle traffic accident, out-vehicle traffic accident, fall from height, assault, gunshot injury, penetrating instrument injury), injury sites accompanying abdominal injury, hospitalization status, and mortality rates were also examined. The statistical distribution of the patients' demographic and clinical information was calculated. The reports and ATA forms of the patients for whom an official radiology report was issued were transferred to SPSS (Statistical Package for the Social Sciences) as "there is pathology" or "no pathology". The evaluations made by ATA and the official radiology report were accepted as valid and compatible as "pathology exists" or "no pathology". In contrast, ATA was deemed to have "pathology present" or "no pathology" and the official radiology report as inconsistent. Results: Of the 207 patients in the study group, 79.2% (n= 164) were male and 20.8% (n= 43) were female. The median age of the patients was 33 years (range = 1-89). In the study, liver injury, spleen injury, kidney injury, intra-abdominal hemorrhage detection, retroperitoneal hemorrhage detection, detection of muscle and fascia injury in the anterior and posterior abdominal wall, vertebral fracture, iliac fracture, ischiadic fracture, pubic fracture, sacrum fracture and femoral neck fracture were evaluated. In the results of the study, a statistically significant correlation was found between the radiologist and ATA in terms of interpretation of abdominal CT. However, no correlation was found between the radiologist and ATA in terms of abdominal CT interpretation in the evaluation of adrenal, stomach, intestinal and pancreatic injuries. Discussion and Conclusion: High sensitivity, specificity, PPD(positive predictive value) and NPD( negative predictive value) values were found in the evaluation of abdominal contrast CT images by the ATA of patients admitted to the emergency department due to trauma. We think that these high accuracy values are due to ATA's evaluation of the patient's anamnesis, physical examination and imaging studies as a whole. More studies are needed on the contrast-enhanced CT evaluation of ATA in emergency departments. Keywords: Trauma, abdominal computed tomography, emergency medicine assistant, emergency department