SMAR3T©-a new time-saving diagnostic emergency room management algorithm

• Published in: Chirurg Vol. 90; no. 10; pp. 845 - 850
• Main Authors: Waldeck, S, Franke, A, Güsgen, C, Schwab, R, Kalff, J, Pantelis, D
• Format: Journal Article
• Language: German
• Published: 01-10-2019
• ISSN: 1433-0385
• DOI: 10.1007/s00104-019-0811-x

BACKGROUNDPrimary computed tomography (CT) plays an increasingly important role in diagnosing life-threatening conditions in polytrauma patients; however, it is associated with two major problems: suboptimal interobserver reliability with unstructured reports especially when the reporting is undertaken by physicians in training during working hours and a delay in beginning urgent surgical interventions, which is mainly due to the time taken until the CT report is available and less to the technical time necessary for the CT. This is why the clinical benefits of a primary CT scan in hemodynamically unstable patients after polytrauma is currently under interdisciplinary discussion. OBJECTIVEThe present study focused on the development and evaluation of a standardized imaging and reporting protocol for initial CT diagnostics of injuries that need immediate treatment after polytrauma. METHODSIn this study 30 patients after polytrauma were subjected to a novel imaging and reporting protocol, SMAR3T, consisting of an imaging protocol with decreased thin-slice axial scan sequences and a standardized structured reporting protocol. These were compared to conventional emergency room CT protocol with respect to time efficiency and quality of the results. RESULTSThe application of the SMAR3T algorithm significantly reduced the time from scan to reporting from an average of 59.6 ± 4.2 min to an average of 8.5 ± 0.6 min (p < 10-23). With the conventional reporting protocol as well as the novel SMAR3T reporting protocol, all life-threatening conditions and injuries requiring immediate treatment were detected. CONCLUSIONBased on the results of 30 CT scans in polytraumatized patients, the SMAR3T algorithm significantly reduced the time to surgical intervention without compromising diagnostic accuracy with respect to life-threatening conditions. Additionally, the reduction in imaging data volume could facilitate telemedical transmission of data to superordinate centers.