Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Abstract

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of full-body linear X-ray scanning (LS) in multiple trauma patients in comparison to 128-multislice computed tomography (MSCT).

Materials and Methods: 106 multiple trauma patients (female: 33; male: 73) were retrospectively included in this study. All patients underwent LS of the whole body, including extremities, and MSCT covering the neck, thorax, abdomen, and pelvis. The diagnostic accuracy of LS for the detection of fractures of the truncal skeleton and pneumothoraces was evaluated in comparison to MSCT by two observers in consensus. Extremity fractures detected by LS were documented.

Results: The overall sensitivity of LS was 49.2 %, the specificity was 93.3 %, the positive predictive value was 91 %, and the negative predictive value was 57.5 %. The overall sensitivity for vertebral fractures was 16.7 %, and the specificity was 100 %. The sensitivity was 48.7 % and the specificity 98.2 % for all other fractures. Pneumothoraces were detected in 12 patients by CT, but not by LS. 40 extremity fractures were detected by LS, of which 4 fractures were dislocated, and 2 were fully covered by MSCT.

Conclusion: The diagnostic accuracy of LS is limited in the evaluation of acute trauma of the truncal skeleton. LS allows fast whole-body X-ray imaging, and may be valuable for detecting extremity fractures in trauma patients in addition to MSCT.

Key Points:

• The overall sensitivity of LS for truncal skeleton injuries in multiple-trauma patients was < 50 %.

• The diagnostic reference standard MSCT is the preferred and reliable imaging modality.

• LS may be valuable for quick detection of extremity fractures.

Citation Format:

• Jöres APW., Heverhagen JT, Bonél H et al. Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography. Fortschr Röntgenstr 2016; 188: 163 – 171

Zusammenfassung

Ziel: Ziel dieser Studie war die Evaluation der diagnostischen Genauigkeit eines Ganzkörper-Linearröntgenscanners (LS) bei Polytraumapatienten im Vergleich zur 128-Zeilen-Mehrschicht-Computertomografie.

Material und Methoden: 106 Polytraumapatienten (33 Frauen; 73 Männer) wurden retrospektiv in diese Studie eingeschlossen. Alle Patienten erhielten eine LS-Untersuchung des gesamten Körpers sowie ein MSCT, welches Hals, Thorax, Abdomen und Becken einschloss. Die diagnostische Genauigkeit von LS hinsichtlich der Detektion von Frakturen des Stammskeletts sowie der Detektion von Pneumothoraces wurde im Vergleich zum MSCT durch zwei Untersucher evaluiert. Extremitätenfrakturen welche durch LS detektiert wurden, wurden dokumentiert.

Ergebnisse: Insgesamt lag die Sensitivität von LS bei 49,2 %, die Spezifität bei 93,3 %, der positive Vorhersagewert 91 % und der negative Vorhersagewert 57,5 %. Die Sensitivität hinsichtlich Wirbelkörperfrakturen war 16,7 % sowie die Spezifität 100 %. Für alle anderen Frakturen betrug die Sensitivität 48,7 % und die Spezifität 98,2 %. Pneumothoraces wurden bei insgesamt 12 Patienten mittels CT detektiert – nicht jedoch durch LS. 40 Extremitätenfrakturen konnten mittels LS erkannt werden, von denen 4 Frakturen disloziert waren und lediglich 2 Frakturen vollständig durch die MSCT Untersuchung erfasst worden sind.

Schlussfolgerung: Die diagnostische Genauigkeit von LS ist in der Evaluation von Traumapatienten hinsichtlich des Stammskelettes limitiert. LS erlaubt eine zügige Ganzkörperröntgenuntersuchung und kann nützlich sein, um Extremitätenfrakturen in Ergänzung zum CT zu detektieren.

Kernaussagen:

• Die Gesamtsensitivität von LS für Verletzungen des Stammskelettes bei Polytraumapatienten beträgt < 50 %.

• Daher ist der diagnostische Referenzstandard MSCT als verlässlicheres bildgebendes Verfahren vorzuziehen.

• LS kann ergänzend für die schnelle Detektion von Extremitätenfrakturen sinnvoll sein.

Key words

multiple trauma - ATLS - full-body X-ray - Lodox

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