Acilde Tüm-Vücut BT Yorumlama ve Kullanım İlkeleri
Özet
Tüm vücut bilgisayarlı tomografi (TVBT), multitravma hastalarının acil servislerde değerlendirilmesinde günümüzde temel tanısal yöntemlerden biri haline gelmiştir. Spiral ve çok kesitli BT teknolojilerinin gelişimiyle birlikte, özellikle yüksek enerjili ve künt travma olgularında çoklu organ yaralanmalarının erken ve doğru biçimde saptanması mümkün olmuştur. Travmanın genç erişkinlerde önde gelen mortalite nedenlerinden biri olduğu göz önünde bulundurulduğunda, TVBT’nin sağladığı hız ve tanısal doğruluk klinik açıdan kritik değer taşımaktadır. Endikasyonlar arasında majör ve politravma, şüpheli klinik muayene, hemodinamik olarak unstabil olgular ve yüksek riskli travma mekanizmaları öne çıkmaktadır. Literatürde retrospektif çalışmalar mortalitede %2–5 oranında azalma bildirse de, randomize kontrollü veriler bu üstünlüğü net biçimde ortaya koymamıştır. Ancak, tanısal sürecin hızlanması, komplikasyonların önlenmesi ve hastanede kalış süresinin kısalması yönünden belirgin faydalar sağlandığı kabul edilmektedir. Gelecekte yapay zekâ tabanlı otomatik algoritmalar, düşük doz protokoller ve teleradyoloji uygulamalarıyla birlikte TVBT’nin travma yönetimindeki etkinliğinin daha da artacağı öngörülmektedir.
Referanslar
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128
Hilbert P, Lefering R, Stuttmann R. Trauma care in Germany: major differences in case fatality rates between centers. Deutsches Ärzteblatt International.2010;107:463–469.
Schoeneberg C, Schilling M, Burggraf M, et al. Reduction in mortality in severely injured patients following the introduction of the "Treatment of patients with severe and multiple injuries" guideline of the German society of trauma surgery–a retrospective analysis of a level 1 trauma center (2010-2012). Injury. 2014;45(3):635–638
Davies RM, Scrimshire AB, Sweetman L, Anderton MJ, Holt EM. A decision tool for whole-body CT in major trauma that safely reduces unnecessary scanning and associated radiation risks: An initial exploratory analysis. Injury. 2016 Jan;47(1):43-9. doi: 10.1016/j.injury.2015.08.036. Epub 2015 Sep 1. PMID: 26377772.
Sato T, Saito Y, Saito N, et al. Multicenter investigation of the effective dose for whole-body CT scanning. Nippon Hoshasen Gijutsu Gakkai Zasshi. 2017;73(4):258–266.
Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with fullbody CT screening. Radiology. 2004 Sep;232(3):735–738 Epub 2004 Jul 23.
Davies RM, Scrimshire AB, Sweetman L, et al. A decision tool for whole-body CT in major trauma that safely reduces unnecessary scanning and associated radiation risks: an initial exploratory analysis. Injury. 2016 Jan;47(1):43–49. https://doi.org/ 10.1016/j.injury.2015.08.036 Epub 2015 Sep. 1.
Gordic S, Alkadhi H, Hodel S, Simmen HP, Brueesch M, Frauenfelder , et al. Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. British Journal of Radiology 2015 Mar;88(1047):20140616. doi: 10.1259/bjr.20140616. Epub 2015 Jan 16. PMID: 25594105; PMCID: PMC4651196.
Huber-Wagner S, Biberthaler P, Häberle S, et al. TraumaRegister DGU, Whole-body CT in haemodynamically unstable severely injured patients–a retrospective, multicentre study. PloS One. 2013;8:e68880.
Sierink JC, Treskes K, Edwards MJ, Beuker BJ, den Hartog D, Hohmann J,et al,REACT-2 study group. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet. 2016 Aug 13;388(10045):673-83. doi: 10.1016/S0140-6736(16)30932-1. Epub 2016 Jun 28. PMID: 27371185.
Fathi M, Hatam abadi HR, Ebrahimi M, et al. Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study. Emergency Radiology 2024;31:1-13.
Stengel D, Ottersbach C, Matthes G, et al. Low-dose whole-body computed tomography for primary assessment of multiple trauma: a randomized, controlled trial. JAMA Surgery 2020;155(5):e200464.
Wirth S, Hebebrand J, Basilico R, Berger FH, Blanco A, Calli C, Dumba M, et al. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging. 2020 Dec 10;11(1):135. doi: 10.1186/s13244-020-00947-7. PMID: 33301105; PMCID: PMC7726597.
Çorbacıoğlu ŞK, Aksel G, Yılmaz S, et al. Whole body computed tomography in multi trauma patients. Ulus Travma Acil Cerrahi Dergisi 2018;24(5):423-9.
Rohner D, Bennett S, Samuratunaga C et al. Cumulative total effective while-body radiation dose in critically ill patients. Chest.2013;144(5):1481-1486
Wada D, Nakamori Y, Yamakawa K, Yoshikawa Y, Kiguchi T, Tasaki O, et al. Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma. Crit Care. 2013 Aug 27;17(4):R178. doi: 10.1186/cc12861. PMID: 24025196; PMCID: PMC4057394.
van Vugt R, Kool DR, Deunk J, Edwards MJ. Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients. Journal of Trauma Acute Care Surgery. 2012 Mar;72(3):553-9. doi: 10.1097/TA.0b013e31822dd93b. PMID: 22491536.
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support: 11th Edition Course Manual. Chicago, IL: American College of Surgeons; 2025.
