MSCT improves workflow in the ER

Multislice CT reinforced by carefully planned logistics can speed throughput of trauma patients in the emergency room, according to a study presented at the 2004 RSNA meeting.

Soon after MSCT's introduction, several research institutions began formulating and testing management algorithms for trauma patients. European institutions have seen encouraging results from the development of a structured diagnostic and treatment process using special logistics in the hands of a trauma team of radiologists, surgeons, and dedicated personnel.

Dr. Ulrich Linsenmaier and colleagues at the Ludwig-Maximilian University Hospital of Munich evaluated workflow in a series of 315 consecutive patients using three different combinations of scanners, nursing assistance, and preparation rooms. They found that, even though MSCT led to an increase in CT productivity in immobile patients only, all structured radiology variables have room for further optimization.

The evaluation included the following combinations:

• a stand-alone MSCT scanner with preparation room

• three centralized MSCT scanners with preparation room and radiology nurses

• a stand-alone single-slice CT scanner without preparation room or nurses

There was no significant difference in study time for mobile patients on any logistic model. The time required for examination of immobile patients was significantly less with MSCT than single-slice CT (p

The management of multiple trauma patients - including initial clinical survey, diagnostic imaging, and therapeutic strategies - has progressed. Plain-film imaging is increasingly giving way to CT, which is now part of the primary survey. Algorithms concerning type of trauma care, ER equipment, and quality assurance have been defined to minimize risks to the patient, said coauthor Dr. Markus Körner.

Patient selection should be done in advance and in accordance with the Advanced Trauma Life Support criteria to provide adequate diagnosis and avoid unnecessary radiation exposure. A good logistic concept should account for appropriate trauma patient transportation inside the hospital and the use of the MSCT scanner for general patients, and CT scanning suites should be implemented in or as near as possible, he said.

"MSCT represents the main diagnostic tool in our ER algorithm. We strongly encourage abandoning any conventional radiological studies other than focused abdominal ultrasound and one initial chest x-ray in intubated patients," Körner said.