- Open Access
European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)
Insights into Imaging volume 11, Article number: 135 (2020)
Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines.
Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org) and a short version also covering all recommendations (this article).
Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
If indicated, whole-body-CT (WBCT) saves lives in severely injured patients.
However, WBCT radiation dose risk versus benefit depends on severity of injury.
Two WBCT protocols should be established (A: time/precision optimised, B: dose reduced).
Protocol A should be used for clinically unstable patients/life-threatening conditions.
For all other patients, protocol B should be selected.
The European Society of Emergency Radiology (ESER) is an apolitical, non-profit organisation, exclusively and directly dedicated to promoting and coordinating the scientific, philanthropic, intellectual and professional activities of Emergency Radiology. The Society’s mission at all times is to serve the health care needs of the general public through the support of science, teaching, research and the quality of service in the field of Emergency Radiology . One particular aim of ESER is to advance and improve the radiological aspects of emergent patient care and to advance the quality of diagnosis and treatment of acutely ill or injured patients using imaging.
Emergency Radiology encompasses medical and surgical subspecialties including polytrauma services. Concerning the latter, past and present ESER board members had taken part in several interdisciplinary guideline processes. However, the ESER board has observed the lack of dedicated separate independent radiological recommendations for a radiological polytrauma service. The ESER has therefore created such recommendations with the hope that this will start to bring corresponding diverse national and international radiological societies together in order to refine the statements, gain visibility for national societies and in particular, strengthen the role of radiology in upcoming interdisciplinary polytrauma guideline development.
As ESER also wants to be a promotor of future scientific work, we hope to give advice on specific questions as well as for a more general principal direction. To update this guideline, ESER will refine the statements at appropriate time intervals, (currently estimated to be two years).
The Guideline on Radiological Polytrauma Imaging and Service is published simultaneously in a comprehensive short version (this article) and a full version (download of the full version from the ESER homepage ). This causes text overlap between the two versions. We mention this to avoid a potential conflict with respect to self-plagiarism.
The ESER Board instructed the former ESER President (S.W.) to divide the entire field of radiological polytrauma care into individual sections. S.W. assigned parts of the project to J.H. as part of his doctoral thesis at the Ludwig-Maximilian-University, Munich, Germany. Each section was processed and prepared according to a fixed schedule: determination of key issue(s), literature research, selection of literature, classification of literature, rating of literature, determining a level of evidence, suggesting a grade of recommendation, suggesting a statement for each key issue as a basis for the consensus conferences.
Each section was related to at least one key issue/question. The consensus conference members had to discuss and vote on one (or more) answer(s) to each key question, but were also allowed to delete or change answers.
For each key issue, a literature search was conducted with subjectively fitting keywords from the MeSH terms (Medical Subject Headings, ) including subjectively fitting synonymous keywords. The MeSH term search itself was performed using NCBI (National Center for Biotechnology Information) . These keywords were used for searching through several databases: MEDLINE (via PubMed ), Cochrane Library  and Embase (via Ovid ). These databases were accessed via the Database Information System (DBIS)  of the University Library of the LMU Munich, where full text access was available for almost all journals. If there was only access to the abstract but not to the full text, the literature was excluded. Depending on the key issue the rate of such exclusion ranged between two and ten percent. Search terms and their connection were adapted to the individual databases. For guidelines, the databases of the NICE (National Institute for Health and Care Excellence ) and AWMF (Association of the Scientific Medical Societies in Germany ) were scanned. The AWMF database in German was included because S.W. and J.H. were able to understand it and, if necessary, translate it for the consensus conferences. The NICE search for guidelines was performed with the additional filter ‘Secondary Evidence’. The literature found was selected in a fixed order. The first step was to evaluate the relevance by title, then by abstract and, if necessary, by keyword search in the full text. Any literature not excluded in this first step was then subject to a more detailed second step examination of the inclusion and exclusion criteria on the basis of the full text. For more (very detailed) information about the literature search please refer to the guideline in full text .
Inclusion/exclusion criteria for literature selection
The literature was selected on the basis of a catalogue of inclusion criteria. The search key words were determined together by S.W. and J.H. according to ‘sections’ and related ‘key issue(s)’. Data were excluded if at least one of the inclusion criteria listed below was not fulfilled.
Publication period from January, 1 2010 to February, 15 2019
Study population: n ≥ 50, adults (an age limit was not applied as children develop at different rates and therefore, from a radiological point of view, there may be a smooth transition to the body of an adult.)
Language of publication: English or German (German because S.W. and J.H. were able to understand it and, if necessary, translate it for the consensus conferences)
Full text accessible, free of charge via the university portal used
Clinical relevance of the literature included with regard to the key issue (subjective evaluation)
Additional criteria for guidelines:
It is published as a guideline, i.e. using the word ‘guideline’ in the title
The guideline is described as being current or no updated version is available
Additional criteria for studies:
Allowed study types: meta-analyses, systematic reviews, randomised controlled trials, cohort studies, case–control studies, cross-sectional studies, before—after studies
Outcome: p-value < 0.05 and/or confidence interval (CI) > 95%
Classification, rating, and evidence level of studies
Classification In case of studies, the algorithm according to Hartling et al.  was used to classify the study type for included publications (e.g. prospective cohort study, case–control study, randomised controlled trial).
Rating Systematic reviews and meta-analyses were rated using AMSTAR 2 , randomised controlled trials using the Cochrane method , and cohort or case control studies using the Newcastle—Ottawa Scale (NOS) . The Cochrane method and NOS have been performed according to the description in the Manual of Cochrane Germany and Association of Scientific Medical Societies in Germany (AWMF)  (e.g. were the items of PICO (population, intervention, comparator group and outcome) applied for a randomised controlled study? Were the sources of funding of the study published? ).
Evidence Level For every study, the level of evidence of was assigned using the scheme of the Oxford Centre for Evidence—Based Medicine in the 2011 version  (e.g. level 1 corresponds to systematic review of randomised trials or level 3 corresponds to a cohort study ).
Grade of recommendation (GoR)
Using the evidence levels according to the AWMF Guidance Manual  one out of three possible Grades of Recommendation (GoR) was issued on each answer to a key question: A = ‘should/ should not’ with the meaning of ‘certainly should/ should not’; B = ‘ought/ ought not’ with the meaning of ‘probably/preferably should/should not’; 0 = ‘may be considered’ or ‘consider’. The GoR was based on the evidence level of the included studies: evidence level 1 led to a recommendation level ‘A’ (strong recommendation), evidence level 2 led to a recommendation level ‘B’ (recommendation) and evidence levels 3, 4, 5 lead to a recommendation ‘0’ (open recommendation). For statements from guidelines, the specific degree of recommendation was adopted from the guideline. Following the AWMF principle  and in case the used scale allowed us to do so, the consensus conference was able to increase or decrease the GoR by one degree of recommendation .
Good clinical practice points (GPP)
If there was insufficient evidence in the literature included, the degree of recommendation—GPP (Good Clinical Practice Points, -p. 27) was used. In contrast to GoR, GPP is based purely on the consensus of the experts. The GPP degrees of recommendation are identical to those for GoR: ‘A’ = strong recommendation, ‘B’ = recommendation and ‘0′ = open recommendation. For differentiation purposes, the degree of recommendation was therefore marked with GPP instead of GoR.
Consensus development at the conferences
For each key issue, S.W. and J.H. proposed a statement with a corresponding level of recommendation (GoR or GPP) to the consensus conference. This served as a basis for the discussion during the consensus conference. If present in person, each member of the last and the current ESER Board (from 2017 until now) had exactly one equal vote. As the consensus conferences were during congress meetings, not all consensus members were able to present for the entire consensus conferences. According to our constitution, attendance by 2/3 of members was considered quorate for each vote on each statement. All members reviewed each statement during the publication process. The suggested statements and grades of recommendation as well as the corresponding literature were sent to the participants in advance by email.
The procedure for each key question is as follows (see also Table 1): For each section, the suggested statement(s) and GoR/GPP were presented by S.W. and a discussion was opened with the possibility of further questions, amendments, additions and objections. This stopped when there seemed to be a majority on the wording and the final suggested or amended statement was then voted on (with % consensus recorded). This was followed by a second vote on the GoR/GPP for this statement (again, the % consensus was recorded). If necessary, a new proposal for GoR/GPP was formed by discussion considering the rules for GoR/GPP (AWMF principle as described earlier) until at least simple majority was reached. Each voting was performed anonymously by holding a laser pointer within a given area, which was interpreted as ‘yes’, outside this area as ‘no’, and missing pointer signals as abstention (did not occur). All voting results were recorded (Tables 2, 3, 4, 5).
An agreement of voting was achieved by a consensus strength of more than 50% of the present votes.
The consensus strength was graduated according to the AWMF rules (-p.40) as follows: Strong (strong agreement): > 95% of votes; Normal (normal agreement): > 75–95%; Weak (majority agreement): > 50–75% and None (no agreement): < 50% (Tables 6, 7, 8, 9, 10).
The results of the consensus conferences are presented here and structured into ten sections. Each section may be subdivided into several key issues that were presented as tables in the following. Each table also holds a collection of ‘key literature’ that corresponds to the literature included. The tables also include a path through the literature classification as well as the evidence levels of the included literature (Tables 11, 12, 13, 14, 15).
Discussion and conclusions
For a detailed literature discussion of more than 50 print pages we have to refer to the guideline in full length (access via ESER homepage ).
As a relatively young society, ESER overcame challenges during the guideline development, consensus and publication process. The members of the consensus group were distributed throughout diverse nations, making the necessary distribution of information and communication time consuming. Financial limitations restrict the whole group from coming together face to face to only once or twice a year, during the European congresses of radiology in Vienna and the ESER congress meetings. This huge project required two sittings of the consensus group to adequately provide time for discussion, this, in addition to restrictions of the SARS-Cov-2 situation and cancellation of the European Congress of Radiology (ECR) 2020 caused unexpected delay in manuscript production (Tables 16, 17, 18, 19).
Only one person was involved in suggesting key issues (S.W.)
Literature search was limited to two persons (S.W., J.H.)
Literature preparation (exclusion, inclusion, grading) was also limited to S.W., J.H.
The preparation of the consensus conference(s) including suggested statements and respective grading of them was limited to S.W., J.H.
Literature inclusion was limited to free full access via the Ludwig-Maximilians University of Munich, Germany. However, this quote was about 95 percent in mean and always above 90 percent.
German was the only non-English language that could be included in the literature search (because S.W. and J.H. were able to understand and translate it for the consensus conference members).
The guideline does not cover special topics like paediatric patients or interventional radiology; these are an aspiration for future editions
By developing this guideline, the ESER aimed to redress the lack of dedicated separate independent radiological recommendations for radiological polytrauma service. ESER recommends that a patient should first be assessed as ‘polytrauma’, who will therefore receive whole-body CT (WBCT) or ‘non-polytrauma’ (assess patient as a ‘normal’ emergency patient in the Emergency Trauma Room: do not automatically perform a WBCT). For a polytrauma service, the CT distance to the Emergency Trauma Room should not exceed 50 m—the closer, the better [15, 19, 20]. The CT used should offer 64 rows and modern technology (cardiac capability is welcome but not essential) [15, 24, 26,27,28,29]. Radiology departments as part of Trauma centres should optimise communication and drive quality assurance/ management [15, 31, 32, 34, 150, 151]. eFAST should be part of the primary survey and Radiography should be immediately available [15, 37,38,39,40,41, 43, 46]. ESER prefers to position patients ‘feet first’. In case of stable patients and if possible, arms should be elevated for dose reduction (only if this is done prior to the body scout) [15, 54, 56, 57]. CT scouts preferably should present the whole patient (but may consist of different parts) [37, 63], may replace chest radiographs [15, 51] and sometimes also provide justification for deviating from the standard protocol by choosing different contrast phases or extend scanning to other suspicious body regions. The unenhanced cranial CT scan certainly should be done first . At least when using the ‘dose’ protocol (WBCT variant B), the cranial CT scan should only cover the brain. For unstable patients, the midface/neck/cervical spine should be scanned together with the chest using arterial contrast including the arteries of the skull base  (for stable patients a separate low-dose scan with or without contrast enhancement may be an alternative before lifting the arms). A split bolus protocol should probably be used with a dose-optimised protocol [74, 101, 108]. Otherwise, ESER recommends overlapping scans of the neck/chest/upper abdomen in arterial phase and the abdomen/pelvis in portal-venous phase [26, 98, 99]. For specific questions related to the urogenital, interventional, (cardio)vascular or paediatric specialties, ESER recommends using existing guidelines from the respective (sub)societies [117, 118, 129,130,131]. First images should be available, read and communicated as fast as possible using the ABCDE approach [19, 66, 143]. In the second step ‘perfect’ images should be calculated (in both soft and enhancing kernels) and be interpreted (and archived) at least in the three standard planes, respectively [19, 65, 66, 144]. Interpretation should occur three times (immediately using first images, immediately reassessed using the final images and reassessed again by a different radiologist within 24 h) [141, 144, 146].
ESER endorses abandoning a ‘one-size-fits-all-concept’ (-p.1142). Instead, ESER recommends introducing a double-track whole-body tomography protocol concept with a ‘Dose Protocol’ and a ‘Time/Precision Protocol’. Obviously, the choice between the two variants should be based on the individual clinical presentation and vital parameters of the polytrauma patient. The ‘Dose protocol’ should be designed in such a way that the patient is exposed to the lowest possible radiation exposure despite sufficient image quality in order to ensure a reliable diagnosis of injuries (often young and stable patients with dramatic injury history and a Glasgow Coma Scale = 15). A dose far below 20 mSv should be aimed for. A good potential ‘Dose protocol’ may consist of an unenhanced head scan, low dose CT of the midface/ neck/ cervical spine (with or without contrast enhancement), elevation of the arms, scout of the trunk, and a single pass scan of chest/ abdomen and pelvis using a split bolus injection protocol with a resulting arterial/venous mixed contrast of all vessels and organs. In (few) cases where a ‘Dose protocol’ scan leaves potentially important findings unclear, another CT scan should be performed accordingly.
In contrast, the ‘Time/Precision protocol’ is optimised for very fast, very high diagnostic accuracy and will more or less correspond to the institutional protocol used so far. The key advantage is the more sensitive detection of active bleeding [15, 19, 107, 108]. The assignment of the polytrauma patient to one of the two protocols is shown in Fig. 1.
The ESER hopes that this guideline motivates diverse national and international radiological societies to come together in order to refine the statements over time. The ESER acknowledges that these guidelines do not focus on the radiological polytrauma service for children and Interventional Radiology. Rather the ESER invites the corresponding national and international radiological (sub)societies to contribute in the future. Where the guidelines do overlap with other radiological communities on topics such as Musculoskeletal, Abdominal & Urogenital imaging, the ESER anticipates arriving at a consensus in the future.
ESER sees this as way to gain visibility for national societies in the field and in particular to strengthen the role of Radiology in upcoming interdisciplinary polytrauma guideline processes. As ESER is active in the whole field of emergency radiology, we also aim to expand the guideline to non-traumatic Emergency Imaging in upcoming versions.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Included literature was however searched as described in databases that are publically available. For more detailed information about the literature search and inclusion process you may refer to the full ESER Guideline that will be published at the ESER homepage (www.eser-society.org).
Association of Scientific Medical Societies in Germany
Cardiovascular and Interventional Radiological Society of Europe
Computed tomography angiography
Database information system
European Society of Radiology
European diploma in radiology
Extended focused assessment with sonography for trauma
European Society of Emergency Radiology
European Society of Neuroradiology
Grade of recommendation
Good clinical practice points
Multi-detector computed tomography
Medical subject headings
National Center for Biotechnology Information
National Institute for Health and Care Excellence
Picture archiving and communication system
Population, intervention, comparator group and outcome
Whole-body computed tomography
European Society of Emergency Radiology. 2011. https://www.eser-society.org/. Accessed 26 Aug 2020
National Center for Biotechnology Information. 1988. https://www-ncbi-nlm-nih-gov.emedien.ub.uni-muenchen.de/mesh/. Accessed 12 Feb 2019
PubMed. 1996. https://www-ncbi-nlm-nih-gov.emedien.ub.uni-muenchen.de/pubmed/advanced. Accessed 12 Feb 2019
Cochrane Library. 1994. https://www-cochranelibrary-com.emedien.ub.uni-muenchen.de/advanced-search. Accessed 12 Feb 2019
Ovid. 1988. https://ovidsp.ovid.com/. Accessed 12 Feb 2019
Datenbank-Infosystem (DBIS). 2002. https://dbis-uni-regensburg-de.emedien.ub.uni-muenchen.de/dbinfo/fachliste.php?bib_id=ub_m&lett=l&colors=&ocolors=. Accessed 12 Feb 2019
National Institute for Health and Care Excellence; 1999. https://www.evidence.nhs.uk/. Accessed 12 Feb 2019
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.; 1962. https://www.awmf.org/leitlinien/leitlinien-suche.html. Accessed 12 Feb 2019
Hartling L, Bond K, Santaguida PL, Viswanathan M, Dryden DM (2011) Testing a tool for the classification of study designs in systematic reviews of interventions and exposures showed moderate reliability and low accuracy. J Clin Epidemiol 64(8):861–871. https://doi.org/10.1016/j.jclinepi.2011.01.010
Shea B, Reeves B, Wells G et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008
Cochrane Deutschland, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften - Institut für Medizinisches Wissensmanagement „Bewertung des Biasrisikos (Risiko systematischer Fehler) in klinischen Studien: ein Manual für die Leitlinienerstellung“. Cochrane Deutschland: http://www.cochrane.de/de/rob-manual; AWMF: http://www.awmf.org/leitlinien/awmf-regelwerk/ll-entwicklung.html.
OCEBM Levels of Evidence Working Group, Howick J, Chalmers IJLL et al "The Oxford 2011 Levels of Evidence". Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653.
German Association of the Scientific Medical Societies (AWMF) - Standing Guidelines Commission. AWMF Guidance Manual and Rules for Guideline Development. http://www.awmf.org/leitlinien/awmf-regelwerk.html. Accessed 08 Feb 2019
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - Ständige Kommission Leitlinien. AWMF - Regelwerk "Leitlinien"; 2012. http://www.awmf.org/leitlinien/awmf-regelwerk.html. Accessed 17 May 2018
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin et al. S3 - Leitlinie Polytrauma/ Schwerverletzten-Behandlung (AWMF-Registernr.: 012/019). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2016. https://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2017-08.pdf. Accessed 29 Jan 2019
Dinh MM, Hsiao KH, Bein KJ et al (2013) Use of computed tomography in the setting of a tiered trauma team activation system in Australia. Emerg Radiol 20(5):393–400. https://doi.org/10.1007/s10140-013-1124-x
Hsiao KH, Dinh MM, McNamara KP et al (2013) Whole-body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection? Emerg Med Aust 25(2):182–191. https://doi.org/10.1111/1742-6723.12041
Treskes K, Saltzherr TP, Luitse JS, Beenen LF, Goslings JC (2017) Indications for total-body computed tomography in blunt trauma patients: a systematic review. Eur J Trauma Emerg Surg 43(1):35–42. https://doi.org/10.1007/s00068-016-0711-4
The Royal College of Radiologists. Standards of practice and guidance for trauma radiology in severely injured patients. Available via NICE, National Instiutue for Health and Care Excellence; 2015. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr155_traumaradiol.pdf. Accessed 29 Jan 2019
Huber-Wagner S, Mand C, Ruchholtz S et al (2014) Effect of the localisation of the CT scanner during trauma resuscitation on survival—A retrospective, multicentre study. Injury 45:76–82. https://doi.org/10.1016/j.injury.2014.08.022
Saltzherr TP, Bakker FC, Beenen LF, Dijkgraaf MG, Reitsma JB, Goslings JC (2012) Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes. Br J Surg 99(1):105–113. https://doi.org/10.1002/bjs.7705
Frellesen C, Boettcher M, Wichmann JL et al (2015) Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management. Eur J Radiol 84(1):117–122. https://doi.org/10.1016/j.ejrad.2014.10.013
Kinoshita T, Yamakawa K, Matsuda H et al (2017) The survival benefit of a novel trauma workflow that includes immediate whole-body computed tomography, surgery, and interventional radiology, all in one trauma resuscitation room: a retrospective historical control study. Ann Surg. https://doi.org/10.1097/sla.0000000000002527
Deutsche Gesellschaft für Angiologie - Gesellschaft für Gefäßmedizin e.V. (DGA), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM), Deutsche Gesellschaft der Anästhesiologie und Intensivmedizin e.V. (DGAI) et al. S2k-Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie (AWMF-Registernr.: 065/002). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2015. https://www.awmf.org/uploads/tx_szleitlinien/065-002l_S2k_VTE_2016-01.pdf. Accessed 29 Jan 2019
Sierink JC, Treskes K, Edwards MJ et al (2016) Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet 388:673–683. https://doi.org/10.1016/S0140-6736(16)30932-1
Alagic Z, Eriksson A, Drageryd E, Motamed SR, Wick MC (2017) A new low-dose multi-phase trauma CT protocol and its impact on diagnostic assessment and radiation dose in multi-trauma patients. Emerg Radiol 24(5):509–518. https://doi.org/10.10007/s10140-017-1496-4
Harrieder A, Geyer LL, Korner M et al (2012) Evaluation der Strahlendosis bei Polytrauma-CT-Untersuchungen eines 64-Zeilen-CT im Vergleich zur 4-Zeilen-CT. Rofo 184(5):443–449. https://doi.org/10.1055/s-0031-1299099
Kahn J, Grupp U, Kaul D, Boning G, Lindner T, Streitparth F (2016) Computed tomography in trauma patients using iterative reconstruction: reducing radiation exposure without loss of image quality. Acta Radiol 57(3):362–369. https://doi.org/10.1177/0284185115580839
Kahn J, Kaul D, Boning G et al (2017) Quality and dose optimized CT trauma protocol-recommendation from a university level-i trauma center. Rofo 189(9):844–854. https://doi.org/10.1055/s-0043-108996
Surendran A, Mori A, Varma DK, Gruen RL (2014) Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients: are we getting the whole picture? J Trauma Acute Care Surg 76(4):1122–1130. https://doi.org/10.1097/ta.0000000000000178
The Royal College of Radiologists. Standards for interpretation and reporting of imaging investigations. Available via NICE, National Instiutue for Health and Care Excellence; 2018. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr181_standards_for_interpretation_reporting.pdf. Accessed 23 Dec 2018
The Royal College of Radiologists. Standards for providing a seven-day acute care diagnostic radiology service. Available via NICE, National Instiutue for Health and Care Excellence; 2015. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr1514_seven-day_acute.pdf. Accessed 20 Jan 2019
Department of Health. Communication (Clinical Handover) in Acute and Children's Hospital Services. National Clinical Guideline No. 11; 2015.
Crönlein M, Holzapfel K, Beirer M et al (2016) Evaluation of a new imaging tool for use with major trauma cases in the emergency department. BMC Musculoskel Disord 17(482):1–8. https://doi.org/10.1186/s12891-016-1337-8
Sheppard CW, Groll AL, Austin CL, Thompson SJ (2018) Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center. Emerg Radiol 25(3):275–280. https://doi.org/10.1007/s10140-017-1575-6
Tewes S, Rodt T, Marquardt S, Evangelidou E, Wacker FK, Von Falck C (2013) Evaluation of the use of a tablet computer with a high-resolution display for interpreting emergency CT scans. Rofo 185(11):1063–1069. https://doi.org/10.1055/s-0033-1350155
National Institute for Health and Care Excellence. Major trauma: assessment and initial management: guidance (ng39); 2016.
Deutsche Gesellschaft für Verbrennungsmedizin (DGV), Deutsche Gesellschaft der Plastischen RuÄCD, Deutsche Interdiszipliäre Vereinigung für Anästhesiologie und Intensivmedizin e. V. (DIVI) et al. S2k-Behandlung thermischer Verletzungen des Erwachsenen (AWMF-Registernr.: 044–001); 2018. https://www.awmf.org/leitlinien/detail/ll/044-001.html. Accessed 04 Dec 2018
Diercks DB, Mehrotra A, Nazarian DJ, Promes SB, Decker WW, Fesmire FM (2011) Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Ann Emerg Med 57(4):387–404. https://doi.org/10.1016/j.annemergmed.2011.01.013
Stengel D, Rademacher G, Ekkernkamp A, Güthoff C, Mutze S (2015) Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma (Review). Cochrane Database Syst Rev 9:1–38. https://doi.org/10.1002/14651858.CD004446.pub4
Abdulrahman Y, Musthafa S, Hakim SY et al (2015) Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm? World J Surg 39(1):172–178. https://doi.org/10.1007/s00268-014-2781-y
Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A (2018) Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT. Am J Emerg Med 36(6):1014–1017. https://doi.org/10.1016/j.ajem.2017.11.019
Becker A, Lin G, McKenney MG, Marttos A, Schulman CI (2010) Is the FAST exam reliable in severely injured patients? Injury 41(5):479–483. https://doi.org/10.1016/j.injury.2009.10.054
Zieleskiewicz L, Fresco R, Duclos G et al (2018) Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: impact on the management of 756 patients. Injury Int J Care Injured 49(10):1774–1780. https://doi.org/10.1016/j.injury.2018.07.002
Sauter TC, Hoess S, Lehmann B, Exadaktylos AK, Haider DG (2017) Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Emerg Med J 34(9):568–572. https://doi.org/10.1136/emermed-2016-205980
Ojaghi Haghighi SH, Adimi I, Vahdati SS, Khiavi RS (2014) Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients. Trauma Mon 19(4):5–8. https://doi.org/10.5812/traumamon.17498
National Institute for Health and Care Excellence. Head injury: assessment and early management: guidance (cg176); 2014.
British Orthopaedic Association, Association of Surgeons of Great Britain and Ireland, The Association of Coloproctology of Great Britain and Ireland. THE MANAGEMENT OF PATIENTS WITH PELVIC FRACTURES. British Orthopaedic Association (BOA); Association of Surgeons of Great Britain and Ireland (ASGBI); 2018. https://www.boa.ac.uk/wp-content/uploads/2018/02/Management-of-Pelvic-Fractures-BOAST.pdf. Accessed 24 Nov 2018
Giannakopoulos GF, Saltzherr TP, Beenen LF et al (2017) Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients. Langenbecks Arch Surg 402(1):159–165. https://doi.org/10.1007/s00423-016-1515-z
Moussavi N, Davoodabadi A, Atoof F, Razi SE, Behnampour M, Talari HR (2015) Routine chest computed tomography and patient outcome in blunt trauma. Arch Trauma Res 4(2):1–5
Gordic S, Alkadhi H, Hodel S et al (2015) Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 88(20140616):1–8. https://doi.org/10.1259/bjr.20140616
Jöres AP, Heverhagen JT, Bonel H, Exadaktylos A, Klink T (2016) Diagnostic accuracy of full-body linear x-ray scanning in multiple trauma patients in comparison to computed tomography. Rofo 188(2):163–171. https://doi.org/10.1055/s-0041-107199
Saltzherr TP, Beenen LF, Reitsma JB, Luitse JS, Vandertop WP, Goslings JC (2010) Frequent computed tomography scanning due to incomplete three-view X-ray imaging of the cervical spine. J Trauma 68(5):1213–1217. https://doi.org/10.1097/TA.0b013e3181b28aa4
Bayer J, Pache G, Strohm PC et al (2011) Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients. J Trauma 70(4):900–905. https://doi.org/10.1097/TA.0b013e3181edc80e
Hickethier T, Mammadov K, Baeßler B et al (2018) Whole-body computed tomography in trauma patients: optimization of the patient scanning position significantly shortens examination time while maintaining diagnostic image quality. Ther Clin Risk Manag 14:849–859. https://doi.org/10.2147/tcrm.S162074
Karlo C, Gnannt R, Frauenfelder T et al (2011) Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality. Emerg Radiol 18(4):285–293. https://doi.org/10.1007/s10140-011-0948-5
Loewenhardt B, Buhl M, Gries A et al (2012) Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning. Injury 43(1):67–72. https://doi.org/10.1016/j.injury.2011.10.014
Kahn J, Grupp U, Maurer M (2014) How does arm positioning of polytraumatized patients in the initial computed tomography (CT) affect image quality and diagnostic accuracy? Eur J Radiol 83(1):e67–e71. https://doi.org/10.1016/j.ejrad.2013.10.002
National Institute for Health and Care Excellence; Spinal injury: assessment and initial management: guidance (ng41); 2016.
National Institute for Health and Care Excellence. Fractures (complex): assessment and management: guidance (ng37); 2016.
Geyer LL, Körner M, Harrieder A et al (2016) Dose reduction in 64-row whole-body CT in multiple trauma: an optimized CT protocol with iterative image reconstruction on a gemstone-based scintillator. Br J Radiol 89(20160003):1–6. https://doi.org/10.1259/bjr.20160003
Linder F, Mani K, Juhlin C, Eklöf H (2016) Routine whole body CT of high energy trauma patients leads to excessive radiation exposure. Scand J Trauma Resusc Emerg Med 24(7):1–7. https://doi.org/10.1186/s13049-016-0199-2
Reske SU, Braunschweig R, Reske AW, Loose R, Wucherer M (2018) Whole-body CT in multiple trauma patients: clinically adapted usage of differently weighted CT protocols. Rofo 190(12):1141–1151. https://doi.org/10.1055/a-0643-4553
American College of Radiology. ACR–ASNR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Brain; 2004. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Brain.pdf?la=en. Accessed 23 Dec 2018
Treskes K, Bos SA, Beenen LFM et al (2017) High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial. Eur Radiol 27(6):2451–2462. https://doi.org/10.1007/s00330-016-4598-6
Fakler JKM, Özkurtul O, Josten C (2014) Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans. Patient Saf Surg 8(36):1–8. https://doi.org/10.1186/s13037-014-0036-3
Hinzpeter R, Sprengel K, Wanner GA, Mildenberger P, Alkadhi H (2017) Repeated CT scans in trauma transfers: an analysis of indications, radiation dose exposure, and costs. Eur J Radiol 88:135–140. https://doi.org/10.1016/j.ejrad.2017.01.007
James MK, Schubl SD, Francois MP, Doughlin GK, Lee SW (2017) Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences? Am J Emerg Med 35(1):13–19. https://doi.org/10.1016/j.ajem.2016.09.027
James MK, Lee SW, Minneman JA et al (2017) Variability in CT imaging of blunt trauma among ED physicians, surgical residents, and trauma surgeons. J Surg Res 213:6–15
Laser A, Kufera JA, Bruns BR et al (2015) Initial screening test for blunt cerebrovascular injury: validity assessment of whole-body computed tomography. Surgery 158(3):627–635. https://doi.org/10.1016/j.surg.2015.03.063
Mistral T, Brenckmann V, Sanders L et al (2017) Clinical judgment is not reliable for reducing whole-body computed tomography scanning after isolated high-energy blunt trauma. Anesthesiology 126(6):1116–1124. https://doi.org/10.1097/ALN.0000000000001617
Schicho A, Luerken L, Meier R et al (2018) Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients. Ther Clin Risk Manag 14:173–178. https://doi.org/10.2147/tcrm.S148176
Whitesell RT, Steenburg SD, Shen C, Lin H (2015) Facial fracture in the setting of whole-body CT for trauma: incidence and clinical predictors. AJR Am J Roentgenol 205(1):4–10. https://doi.org/10.2214/ajr.14.13589
Yaniv G, Portnoy O, Simon D, Bader S, Konen E, Guranda L (2013) Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT. Clin Radiol 68(7):668–675. https://doi.org/10.1016/j.crad.2012.12.011
Fleck SK, Langner S, Baldauf J, Kirsch M, Kohlmann T, Schroeder HWS (2011) Incidence of blunt craniocervical artery injuries: use of whole-body computed tomography trauma imaging with adapted computed tomography angiography. Neurosurgery 69(3):615–623. https://doi.org/10.1227/NEU.0b013e31821a8701
American College of Radiology. ACR Appropriateness Criteria® Suspected Spine Trauma. American College of Radiology; 2018. https://acsearch.acr.org/docs/69359/Narrative/. Accessed 29 Dec 2018
American College of Radiology. ACR–ASNR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Extracranial Head and Neck; 2001. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Head-Neck.pdf?la=en. Accessed 20 Jan 2019
American College of Radiology. ACR Appropriateness Crtieria® Penetrating Neck Injury. American College of Radiology; 2017. https://acsearch.acr.org/docs/3099165/Narrative/. Accessed 29 Dec 2018
American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA); 2011. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Body-CTA.pdf?la=en. Accessed 29 Jan 2019
Party. PbtISW. National clinical guideline for stroke. Royal College of Physicians (RCP); 2016. https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx. Accessed 29 Dec 2018
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie e.V. (DGOOC), Österreichische Gesellschaft für Unfallchirurgie. Verletzungen der oberen Halswirbelsäule (AWMF-Registernr.: 012–011). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2018. https://www.awmf.org/uploads/tx_szleitlinien/012-011l_S1_Verletzungen-der-oberen-HWS_2018-09.pdf. Accessed 29 Dec 2018
Deutsche Gesellschaft Für Unfallchirurgie e.V. (DGU), Österreichische Gesellschaft für Unfallchirurgie (ÖGU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). Verletzungen der subaxialen Halswirbelsäule (AWMF-Registernr.: 012–032). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2017. https://www.awmf.org/uploads/tx_szleitlinien/012-032l_S1_Verletzungen-der-sububaxialen-HWS_2018-01.pdf. Accessed 29 Dec 2018
Hennerici MG, Kern R et al (2017) S1-Leitlinie Diagnostik akuter zerebrovaskulärer Erkrankungen. www.dgn.org/leitlinien. Accessed 23 Dec 2018
Weimar C, Kurth T et al (2018) Zerebrale Venen- und Sinusthrombose, S2k-Leitlinie. https://www.awmf.org/uploads/tx_szleitlinien/030-098l_S2k_Zerebrale_Venen_Sinusthrombose_2018-08.pdf. Accessed 10 Jan 2019
Franz RW, Willette PA, Wood MJ, Wright ML, Hartman JF (2012) A Systematic review and meta-analysis of diagnostic screening criteria for blunt cerebrovascular injuries. J Am Coll Surg 214(3):313–327. https://doi.org/10.1016/j.jamcollsurg.2011.11.012
Gupta M, Schriger DL, Hiatt JR et al (2011) Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma. Ann Emerg Med 58(5):407–416. https://doi.org/10.1016/j.annemergmed.2011.06.003
Grandhi R, Weiner GM, Agarwal N et al (2018) Limitations of multidetector computed tomography angiography for the diagnosis of blunt cerebrovascular injury. J Neurosurg 128(6):1642–1647. https://doi.org/10.3171/2017.2.JNS163264
Payabvash S, McKinney AM, McKinney ZJ, Palmer CS, Truwit CL (2014) Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: the role of cervical CT and CT angiography. Eur J Radiol 83(3):571–577. https://doi.org/10.1016/j.ejrad.2013.11.020
Varjonen EA, Bensch FV, Pyhältö TT, Koivikko MP, Snäll J (2018) Remember the vessels! craniofacial fracture predicts risk for blunt cerebrovascular injury. J Oral Maxillofac Surg 76(7):1509.e1501-1509.e1509. https://doi.org/10.1016/j.joms.2018.03.035
American College of Radiology. ACR Appropriateness Criteria® Blunt Chest Trauma; 2013. https://acsearch.acr.org/docs/3082590/Narrative/. Accessed 29 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Blunt Chest Trauma—Suspected Aortic Injury; 1995. https://acsearch.acr.org/docs/69410/Narrative/. Accessed 29 Jan 2019
American College of Radiology. ACR–NASCI–SPR Practice Parameter for the Performance and Interpretation of Cardiac Computed Tomography (CT); 2006. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CardiacCT.pdf?la=en. Accessed 29 Jan 2019
American College of Radiology. ACR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Abdomen and Computed Tomography (CT) of the Pelvis; 1995. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Abd-Pel.pdf?la=en. Accessed 29 Jan 2019
American College of Radiology. ACR–SCBT-MR–SPR Practice Parameter for the Performance of Thoracic Computed Tomography (CT); 1995. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Thoracic.pdf?la=en. Accessed 29 Jan 2019
American College of Radiology ACR Appropriateness Criteria® Pulsatile Abdominal Mass, Suspected Abdominal Aortic Aneurysm; 2016. https://acsearch.acr.org/docs/69414/Narrative/. Accessed 29 Jan 2019
Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin - Gesellschaft für operative endovaskuläre und präventive Gefäßmedizin e.V. (DGG), Deutsche Röntgengesellschaft (DRG), Deutsche Gesellschaft für Angiologie - Gesellschaft für Gefäßmedizin e.V. (DGA) et al. S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas (AWMF-Registernr.: 004/014). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2018. https://www.awmf.org/uploads/tx_szleitlinien/004-014l__S3_Bauchaortenaneurysma_2018-08.pdf. Accessed 29 Jan 2019
Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin - Gesellschaft für operative endovaskuläre und präventive Gefäßmedizin e.V. (DGG), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Angiologie - Gesellschaft für Gefäßmedizin e.V. (DGA) et al. S2k Typ B Aortendissektion (AWMF-Registernr.: 004/034). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2018. https://www.awmf.org/uploads/tx_szleitlinien/004-034l_S2k_Typ_B_Aortendissektion_2018-09.pdf. Accessed 29 Jan 2019
Deutsche Gesellschaft für Gastroenterologie Verdauungs- und Stoffwechselkrankheiten (DGVS), Deutsche Röntgengesellschaft (DRG), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV) et al. S2k Leitlinie Gastrointestinale Blutung (AWMF-Registernr.: 021/028). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2017. https://www.awmf.org/uploads/tx_szleitlinien/021-028l_S2k_Gastrointestinale_Blutung_2017-07.pdf. Accessed 29 Jan 2019
Chidambaram S, Goh EL, Khan MA (2017) A meta-analysis of the efficacy of whole-body computed tomography imaging in the management of trauma and injury. Injury 48(8):1784–1793. https://doi.org/10.1016/j.injury.2017.06.003
Hallinan JTPD, Tan CH, Pua U (2016) The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma. Singapore Med J 57(9):497–502. https://doi.org/10.11622/smedj.2015179
Leung V, Sastry A, Woo TD, Jones HR (2015) Implementation of a split-bolus single-pass CT protocol at a UK major trauma centre to reduce excess radiation dose in trauma pan-CT. Clin Radiol 70(10):1110–1115. https://doi.org/10.1016/j.crad.2015.05.014
Naulet P, Wassel J, Gervaise A, Blum A (2013) Evaluation of the value of abdominopelvic acquisition without contrast injection when performing a whole body CT scan in a patient who may have multiple trauma. Diagn Interven Imaging 94(4):410–417. https://doi.org/10.1016/j.diii.2013.01.018
Sedlic A, Chingkoe CM, Tso DK, Galea-Soler S, Nicolaou S (2013) Rapid imaging protocol in trauma: a whole-body dual-source CT scan. Emerg Radiol 20(5):401–408. https://doi.org/10.1007/s10140-013-1139-3
Forman MJ, Mirvis SE, Hollander DS (2013) Blunt thoracic aortic injuries: CT characterisation and treatment outcomes of minor injury. Eur Radiol 23(11):2988–2995. https://doi.org/10.1007/s00330-013-2904-0
Foster BR, Anderson SW, Uyeda JW, Brooks JG, Soto JA (2011) Integration of 64-detector lower extremity CT angiography into whole-body trauma imaging: feasibility and early experience. Radiology 261(3):787–795. https://doi.org/10.1148/radiol.11100604
Frellesen C, Stock W, Kerl JM et al (2014) Topogram-based automated selection of the tube potential and current in thoraco-abdominal trauma CT: a comparison to fixed kV with mAs modulation alone. Eur Radiol 24(7):1725–1734. https://doi.org/10.1007/s00330-014-3197-7
Furlan A, Tublin ME, Rees MA, Nicholas DH, Sperry JL, Alarcon LH (2017) Delayed splenic vascular injury after nonoperative management of blunt splenic trauma. J Surg Res 211:87–94. https://doi.org/10.1016/j.jss.2016.11.062
Hakim W, Kamanahalli R, Dick E, Bharwani N, Fetherston S, Kashef E (2016) Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection. Br J Radiol 89:20160160. https://doi.org/10.1259/bjr.20160160
American College of Radiology. ACR–ASNR–SPR Practice Parameter for the Performance and Interpretation of Cervicocerebral Computed Tomography Angiography (CTA); 2010. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CervicoCerebralCTA.pdf?la=en. Accessed 29 Jan 2019
American College of Radiology. ACR–SPR Practice Parameter for the Use of Intravascular Contrast Media. American College of Radiology; 2001. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/IVCM.pdf?la=en. Accessed 20 Jan 2019
Schicho A, Lürken L, Meier R et al (2018) Non-penetrating traumatic injuries of the aortic arch. Acta Radiol 59(3):275–279. https://doi.org/10.1177/0284185117713352
Cotte J, Courjon F, Beaume S et al (2016) Vittel criteria for severe trauma triage: characteristics of over-triage. Anaesth Crit Care Pain Med 35(2):87–92. https://doi.org/10.1016/j.accpm.2015.06.013
American College of Radiology. ACR Appropriateness Criteria® Hematuria; 1995. https://acsearch.acr.org/docs/69490/Narrative/. Accessed 16 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Renal Trauma; 1996. https://acsearch.acr.org/docs/69373/Narrative/. Accessed 16 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Suspected Lower Urinary Tract Trauma; 1996. https://acsearch.acr.org/docs/69376/Narrative/. Accessed 16 Jan 2019
American College of Radiology. ACR-SAR Practice Parameter for the Performance of Adult Cystography and Urethrography; 1992. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Cysto-Urethro.pdf?la=en. Accessed 16 Jan 2019
American Urological Association. Urotrauma : AUA Guideline. American Urological Association; 2014. https://www.auanet.org/documents/education/clinical-guidance/Urotrauma.pdf. Accessed 16 Jan 2019
Summerton DJ, Djakovic N, Kitrey ND et al. Guidelines on Urological Trauma. European Association of Urology (EAU); 2014. http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urological-Trauma_LRV2.pdf. Accessed 16 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding. American College of Radiology; 2006. https://acsearch.acr.org/docs/69457/Narrative/. Accessed 24 Jan 2019
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Österreichische Gesellschaft für Unfallchirurgie. S2e Sprunggelenkfraktur (AWMF-Registernr.: 012/003). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2015. https://www.awmf.org/uploads/tx_szleitlinien/012-003l_S2e_Sprunggelenkfraktur_2016-02.pdf. Accessed 23 Jan 2019
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Österreichische Gesellschaft für Unfallchirurgie. S1 Unterschenkelschaftfraktur (AWMF-Registernr.:012/018). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2017. https://www.awmf.org/uploads/tx_szleitlinien/012-018l_S1_Unterschenkelschaftfraktur_2017-08.pdf. Accessed 23 Jan 2019
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Österreichische Gesellschaft für Unfallchirurgie. S1 Oberarmkopffraktur (AWMF-Registernr.: 012/023). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2017. https://www.awmf.org/uploads/tx_szleitlinien/012-023l_S1_Oberarmkopffraktur_2017-10.pdf. Accessed 23 Jan 2019
Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). S1 Oberschenkelschaftfraktur (AWMF-Registernr.: 012/027). Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2018. https://www.awmf.org/uploads/tx_szleitlinien/012-027l_S1_Oberschenkelschaftfraktur_2018-07.pdf. Accessed 26 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Acute Chest Pain-Suspected Aortic Dissection; 1995. https://acsearch.acr.org/docs/69402/Narrative/. Accessed 28 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Suspected Thoracic Aortic Aneurysm; 2017. https://acsearch.acr.org/docs/3102329/Narrative/. Accessed 24 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Acute Nonspecific Chest Pain—Low Probability of Coronary Artery Disease; 1998. https://acsearch.acr.org/docs/69401/Narrative/. Accessed 28 Jan 2019
American College of Radiology. ACR–SAR–SPR Practice Parameter for the Performance of Computed Tomography (CT) Enterography; 2015. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Entero.pdf?la=en. Accessed 28 Jan 2019
American College of Radiology. ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia; 2018. https://acsearch.acr.org/docs/70909/Narrative/. Accessed 28 Jan 2019
Guidelines ESC, on the Diagnosis and Treatment of Peripheral Arterial Diseases, (2018) in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J 39(9):763–821. https://doi.org/10.1093/eurheartj/ehx095
Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ (2015) ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol 110:18–44. https://doi.org/10.1038/ajg.2014.395
Goldstein SA, Evangelista A, Abbara S et al (2015) Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 28(2):119–182. https://doi.org/10.1016/j.echo.2014.11.015
Riambau V, Böckler D, Brunkwall J et al (2017) Editor´s choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53:4–52. https://doi.org/10.1016/j.ejvs.2016.06.005
Menke J (2010) Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 256(1):93–101. https://doi.org/10.1148/radiol.10091938
Colip CG, Gorantla V, LeBedis CA, Soto JA, Anderson SW (2017) Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol 24(3):223–232. https://doi.org/10.1007/s10140-016-1469-z
Shalhub S, Starnes BW, Brenner ML et al (2014) Blunt abdominal aortic injury: a Western Trauma Association multicenter study. J Trauma Acute Care Surg 77(6):879–885. https://doi.org/10.1097/ta.0000000000000353
Geyer LL, Körner M, Linsenmaier U et al (2013) Incidence of delayed and missed diagnoses in whole-body multidetector CT in patients with multiple injuries after trauma. Acta Radiol 54(5):592–598. https://doi.org/10.1177/0284185113475443
Panda A, Kumar A, Gamanagatti S et al (2017) Can multidetector CT detect the site of gastrointestinal tract injury in trauma? A retrospective study. Diagn Interv Radiol 23(1):29–36. https://doi.org/10.5152/dir.2016.15481
American College of Radiology. ACR Practice Parameter for Radiologist Coverage of Imaging Performed in Hospital Emergency Departments; 2000. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/HospER.pdf?la=en. Accessed 04 Dec 2018
The Royal College of Radiologists (2016) Standards for the communication of radiological reports and fail-safe alert notification. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr164_failsafe.pdf. Accessed 04 Dec 2018
National Institute for Health and Care Excellence, College of Paramedics, Resuscitation Coucil (UK) et al (2018) Trauma: guidance (gs166).
James MK, Francois MP, Yoeli G, Doughlin GK, Lee SW (2017) Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. Emerg Radiol 24(4):347–353. https://doi.org/10.1007/s10140-017-1479-5
Muhm M, Danko T, Schmitz K, Winkler H (2012) Delays in diagnosis in early trauma care: evaluation of diagnostic efficiency and circumstances of delay. Eur J Trauma Emerg Surg 38(2):139–149. https://doi.org/10.1007/s00068-011-0129-y
Viergutz T, Terboven T, Henzler T, Schäfer D, Schönberg SO, Sudarski S (2018) Relevante Zufallsbefunde und iatrogene Verletzungen : Eine retrospektive Analyse von 1165 Schockraumpatienten. Der Anaesthesist. https://doi.org/10.1007/s00101-018-0505-7
Banaste N, Caurier B, Bratan F, Bergerot JF, Thomson V, Millet I (2018) Whole-body CT in patients with multiple traumas: factors leading to missed injury. Radiology 289(2):374–383. https://doi.org/10.1148/radiol.2018180492
Eurin M, Haddad N, Zappa M et al (2012) Incidence and predictors of missed injuries in trauma patients in the initial hot report of whole-body CT scan. Injury 43(1):73–77. https://doi.org/10.1016/j.injury.2011.05.019
Ferree S, Houwert RM, van Laarhoven JJEM, Smeeing DPJ, Leenen LPH, Hietbrink F (2016) Tertiary survey in polytrauma patients should be an ongoing process. Injury 47(4):792–796. https://doi.org/10.1016/j.injury.2015.11.040
Briggs RH, Rowbotham E, Johnstone AL, Chalmers AG (2010) Provisional reporting of polytrauma CT by on-call radiology registrars. Is it safe? Clin Radiol 65(8):616–622. https://doi.org/10.1016/j.crad.2010.04.010
Smith CM, Mason S (2012) The use of whole-body CT for trauma patients: survey of UK emergency departments. Emerg Med J 29(8):630–634. https://doi.org/10.1136/emj.2011.111708
Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373(9673):1455–1461. https://doi.org/10.1016/s0140-6736(09)60232-4
Mueck FG, Wirth K, Muggenthaler M et al (2016) Radiological mass casualty incident (MCI) workflow analysis: single-centre data of a mid-scale exercise. Br J Radiol 89(1–6):20150918. https://doi.org/10.1259/bjr.20150918
Mück F, Wirth K, Muggenthaler M et al (2016) Prätherapeutische Ablaufanalyse bei einem Massenanfall von Verletzten: Vergleich von zwei Traumazentren der höchsten Versorgungsstufe. Der Unfallchirurg 119(8):632–641. https://doi.org/10.1007/s00113-016-0200-6
The Guideline on Radiological Polytrauma Imaging and Service is published simultaneously in a short version (this article) and a full version (free download of the full version from the ESER homepage ). This causes text overlap between the two versions (download of the full version from the ESER homepage ). We mention this to avoid a potential conflict with respect to self-plagiarism. ESER wants to thank Ricarda Posch and Wolfgang Duchek (both ESER office) as well as Sabine Grab (former secretary of S.W.) for their organisational support. ESER also wants to thank Maureen Dumba for her encouragement on behalf of ESER in social media.
Open Access funding enabled and organized by Projekt DEAL. No funding was available during the development of the whole ESER-Guideline process. In the future ESER may aim to reach funding from companies. If such a funding should arise in the future, this would reach ESER but not particular authors and ESER declares that such a funding income would be spent on educational purposes like free publication of the Guideline via the ESER homepage or at congress meetings, support of the EDiR diploma or educational parts of ESER congress meetings.
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S.W. is past president of the European Society of Emergency Radiology (ESER). RB is ESER president elect. CC is ESER vice president, treasurer of the European Society of Neuroradiology, chief financial officer of the European Board of Neuroradiology, general secretary of the Turkish Society of Radiology. AB is ESER Secretary, core committee member for the European Diploma in Radiology, board member of the Spanish Society of Emergency Radiology. FB is ESER member at large, member of the Executive Committees of the American Society of Emergency Radiology (ASER) and the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS). MD is ESER member at large and digital lead. KN is ESER Treasurer. MW is ESER member at large, chairman of the working group ultrasonography of the German Radiological Society (DRG) and will be congress president ESSR (European Society of Musculoskeletal Radiology) Annual Meeting 2022. ED is current ESER president. In 2019 ED was hosted by Everlight Radiology Ltd for 3 months in Sydney doing remote reporting for Imperial College, in return for which ED delivered 2 webinars. In 2019 Guerbet donated Euro 750 to the Kenyan Association of Radiologists/ESER after ED delivered lectures for Guerbet at ECR 2019. Otherwise, the authors declare that they have no competing interests.
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Wirth, S., Hebebrand, J., Basilico, R. et al. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 11, 135 (2020). https://doi.org/10.1186/s13244-020-00947-7