Relevance of Whole-body Computed Tomography Prescription in the Emergency Department : an Identification Tool for Low Risk Patients

Pertinence de la PREscription du Scanner Corps-Entier Aux Urgences : un Outil d'Identification Des Patients à Bas Risque

The whole-body scanner (SCE) is a powerful examination that guides the management of patients severely traumatized. However, the systematic use of this examination in emergency departments is responsible for a large proportion of normal examinations. In addition to the non-negligible direct cost, the average irradiation of 20 mSv would give an adult a 1 in 1000 risk of developing a cancer. The Vittel score makes it possible to categorize pre-hospital patients as seriously traumatized to guide the sending of resources and direct them to a center equipped with a suitable technical platform.

The use of this score to condition the prescription of the ECS is at the origin of an over-triage important since one out of two patients who validates at least one criterion has no lesion on imaging. The purpose of this research project is to validate a decision support tool to objectively guide the emergency physician in its use of the ECS. At the same time, the economic impact of such a procedure will be analysed.

Inclusion Criteria:

• Any adult patient undergoing an SCE as part of a post-traumatic lesion assessment during a stay in the emergency room.
• Mechanism of injury: road accident or fall.
• Patient having read and understood the information letter and given his oral consent.

Exclusion Criteria:

• Neurological impairment defined by a Glasgow score of less than 8.
• Respiratory failure with SpO2 < 90% on oxygen or with the use of ventilatory assistance.
• Hemodynamic failure with vascular filling greater than 1000 cc or recourse to catecholamines.
• Acute alcoholism.
• Taking narcotics.
• History of cognitive disorders.
• Current pregnancy.
• Suicidal patient.
• Trauma related to a brawl
• Penetrating trauma.
• Hemophilia.
• Known thrombocytopenia at the time of inclusion.
• Heart, lung, liver or kidney transplant patient.
• Person deprived of liberty by an administrative or judicial decision or person placed under legal safeguard / sub-tutorship or curatorship.