Computertomographie bei Polytrauma.

Whole body computed tomography (CT) currently represents the gold standard for the diagnostics of severely injured and multiple trauma patients in Germany. Studies from the TraumaRegister DGU® have shown a survival advantage for multiple trauma patients, when a whole body CT has been performed; however, even though this standard is applied nationwide in Germany in line with the white book on medical care of the severely injured, it has become apparent that there is no gold standard defining this procedure. The indications for as well as the performance of a whole body CT are subject to many variations. This review article presents the various indications and methods of conducting a trauma CT and in particular addresses the imaging of blood vessels supplying the brain using contrast media. In this respect the literature clearly demonstrates greatly differing incidence rates of traumatic carotid artery dissection (<1-4.6 %). Our own observations have shown an incidence rate of 6.6 % in multiple trauma patients with an injury severity score (ISS) ≥ 16 and 10 % in the subgroup of motorcyclists. Furthermore, it has been revealed that the tracer diagnostics and screening criteria indicators listed in the literature for imaging of the neck vessels with contrast media, only identified approximately half of the patients suffering from a carotid artery dissection. Based on the literature and own results the authors recommend the following procedure for a trauma CT: at least a 16-slice CT, patient positioned with arms crossed diagonally downwards on the chest, cranial CT without contrast media, use of contrast media and CT using contrast media from the head to the trochanters. [ABSTRACT FROM AUTHOR]