Improving the utilization of imaging in trauma

Abstract

This thesis evaluates the current utilization of chest radiography in acute trauma care and after chest tube removal and provides insight into novel applications of modern radiologic diagnostics. In the first part, the role of chest radiography in acute trauma care is evaluated. We showed that in trauma patients acutely admitted to the emergency department, the routine chest radiographs add little clinical value, as most patients subsequently undergo a chest CT. Only few and non-urgent interventions were performed based on radiographic findings before a chest CT was acquired. Omission of chest radiography in non-compromised trauma patients presenting in the trauma bay seems safe, provided that a chest CT is already indicated. Regarding chest tube removal, we showed that postremoval chest radiography only rarely leads to acute reinterventions, especially in the absence of symptoms. Therefore, it seems safe to omit routine postremoval chest radiography in nonventilated trauma patients and to use chest radiography selectively in patients demonstrating symptoms of recurrent pleural pathology. In the second part, we developed reference values of CT-based body composition parameters of muscle, fat and bone mineral density, as measured on axial CT images. L1 bone mineral density values were compared to an extensive North American reference study, showing overall lower bone mineral density values in the Dutch population. These body composition parameters were further explored for associations with clinical outcomes in trauma patients. The psoas muscle index was independently associated with intensive care unit admission and disability at discharge. Psoas muscle density was independently associated with an increased risk of pneumonia, delirium, intensive care unit admission, and disability. Visceral fat was associated with an increased risk of developing delirium. CT-based L1 bone mineral density was independently associated with an increased risk of pneumonia, delirium and intensive care unit admission.