Performing a whole body computerized tomography (CT) scan after a motor vehicle crash
(MVC) when the physical exam suggests no new injury remains a source of debate. It
remains a common practice despite prospective evidence of no reduction in mortality.
Prior retrospective studies have shown a potential mortality benefit of whole-body
CT following these traumas compared to selective scanning, but the overall quality
of evidence is lacking. Proponents argue that whole-body CT finds more injuries and
injuries that may have been missed on exam, but it comes with the cost of radiation
exposure, possible adverse effects of iodine contrast, and added expense. The Vittel
criteria, originally used for field triage, now guide whole-body CT decisions in France.
The Vittel criteria include physiologic variables, kinetic components or mechanism
of injury, injuries sustained, and resuscitation required. Use of these criteria as
an indication to perform whole-body CT has lacked specificity. Investigators in this
retrospective study hypothesized that patients involved in an MVC with a GCS of 15,
a normal exam of the torso, and only a kinetic component of the Vittel criteria, whole-body
CT is not indicated.
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