Emergence Teleradiology
Radiology Recommendations in Trauma

Guidelines:

  • Primary X-ray evaluation of the trauma patient on the spine board should include AP chest, AP pelvis, and lateral cervical spine only.
  • CT should be performed after the initial X-ray survey and can be directed by both the physical exam as well as radiographic results of the primary X-ray survey.
  •  Once primary X-ray and CT survey has been performed and patient is stabilized then patient can be brought to radiology for secondary X-ray imaging based on physical exam.
  • Oral contrast is NOT needed in trauma patients.
  • CT of the Chest and Abdomen Pelvis for blunt abdominal trauma should always include IV contrast.
  • In seriously injured patients waiting for BUN/Cr should not delay CT scan with IV contrast.
  • All Trauma CT exams with exception of Head should have coronal and sagittal reconstructions.
  • If hematuria or suspicion of renal injury; then delays should be performed on abdomen pelvis CT in addition to routine imaging.
  • If a spinal fracture is found at one level. Recommend CT of entire spine as 10-15% have a second fracture.
  • Shield critically injured pregnant and pediatric patients when performing CT.

Principles:

  1. Do not delay transfer of a patient to another facility in order to perform secondary X-ray imaging.
  2. Fear of cancer risk from CT scans should never influence appropriate radiologic evaluation.
  3. Waiting for BUN/Cr results to return in a critically injured patient could result in further decline in patient.
  4. Cervical collar should never be removed by non-clinician. To clear a cervical spine need radiographic and clinical clearance.
  5. Perform the Head CT first in trauma setting prior to CT with contrast. Once contrast has been administered subarachnoid hemorrhage cannot be excluded for 2-3 days.

***These are guideline and principle recommendations only and should not replace care of patient by Trauma physician or inhibit Trauma physician from caring for patient. Trauma physician’s orders should be followed at all times. If your hospital has a set trauma protocol in place then that should supersede this document.***