Mechanism of injury and whole body CT scan utilization in trauma patients: A Retrospective analysis, UAE

ABSTRACT: Background: The mechanism of injury (MOI) plays a crucial role in guiding the use of whole-body computed tomography (CT) in trauma patients, particularly those presenting with deteriorating vital signs. Identifying distinct injury patterns associated with various MOIs is essential for optimizing clinical decision-making in the emergency department. Objective: This study aims to evaluate the efficacy of whole-body CT in the assessment of trauma patients at Hatta Hospital, with a specific focus on the influence of MOI and vital signs on the detection of internal injuries. Methods: We conducted a retrospective cohort study involving 72 patients who underwent whole-body CT scans between August 2023 and September 2024. Patients were classified as CT 'positive' if any internal injuries were detected and 'negative' if no injuries were identified. Comprehensive data on MOI, vital signs, and relevant clinical findings were systematically collected. The study concentrated on patients involved in severe motor vehicle collisions (MVCs) and high-risk mechanisms of injury, while excluding those with minor injuries. Discussion: This retrospective analysis highlights the critical role of mechanism of injury (MOI) and vital signs in guiding the utilization of whole-body CT imaging in trauma patients. Our findings reinforce the value of integrating pre-arrival data with clinical judgment to improve diagnostic accuracy and resource allocation in the emergency department. A key observation from our study is the high proportion (62.5%) of positive CT findings among patients with high-energy trauma mechanisms, notably falls from significant heights, high-speed motor vehicle collisions, and vehicle rollovers. These findings are consistent with existing literature, which suggests that whole-body CT is most beneficial in cases involving high kinetic energy transfer, where the likelihood of occult injuries is elevated. The statistically significant association between positive CT results and clinical indicators—such as neurological deficits, intra-abdominal trauma, and head injuries—underscores the importance of a comprehensive initial assessment. These correlations suggest that whole-body CT should be promptly considered in patients presenting with abnormal neurological examinations or signs of multi-system trauma, even in the absence of overt external injuries. Conversely, our data suggest that in patients exposed to lower-energy mechanisms without significant abnormalities in vital signs or clinical findings, the diagnostic yield of whole-body CT is markedly reduced. This supports a more selective imaging strategy in such cases, which may help minimize unnecessary radiation exposure, reduce healthcare costs, and streamline emergency care workflows without compromising patient safety. Our study has several limitations. Being retrospective and single-centered, the findings may not be generalizable across different trauma systems or populations. The relatively small sample size also limits the statistical power of subgroup analyses. Furthermore, selection bias may exist, as the decision to perform a whole-body CT was at the discretion of the attending physician, potentially influenced by subjective factors not captured in the dataset. Despite these limitations, the study provides valuable insights into the practical utility of whole-body CT in trauma care. It emphasizes the need for evidence-based protocols that incorporate MOI and clinical indicators to guide imaging decisions. Future prospective studies with larger sample sizes and multicenter data are warranted to validate and refine these findings. Results: Of the 72 patients, 45 (62.5%) demonstrated positive CT findings. The predominant MOIs included falls from heights exceeding 3 meters (25%), high-speed collisions (≥60 km/h) (18.75%), and vehicle rollovers (15.6%). Statistical analysis revealed significant associations between positive CT results and clinical findings, including neurological deficits (p < 0.01), intra-abdominal injuries (p < 0.05), and head injuries (p < 0.05). Conclusions: Pre-arrival data, encompassing MOI and vital signs, are critical for the accurate identification of internal injuries via CT imaging. In cases of high-energy trauma, whole-body CT should be considered based on these parameters. Conversely, in low-energy trauma scenarios lacking supportive clinical findings, the probability of a positive CT result is significantly diminished. Keywords: CT Scan, Trauma, Injury