🩺 Introduction
In acute trauma, time = life. CT has become the workhorse in emergency departments (ED) for rapid assessment of polytrauma patients. A standardized CT protocol ensures fast diagnosis of life-threatening injuries, guides surgical decision-making, and minimizes missed injuries.
⚡ General Principles
- Whole-body CT (“pan-scan”) is standard in major trauma.
- Coverage: Head to pelvis in a single session.
- Goals:
- Detect intracranial hemorrhage, cervical spine injury.
- Identify thoracic/abdominal bleeding.
- Assess pelvis, spine, and extremities if indicated.
💻 Acute ED CT Protocol
1️⃣ Non-contrast CT Head
- Detects intracranial hemorrhage, skull fractures, brain injury.
- Often extended to cervical spine (non-contrast) in trauma.
2️⃣ Contrast-Enhanced CT (Venous/Portal Phase)
- Neck, chest, abdomen, pelvis in a single acquisition.
- Uses contrast bolus (IV iodinated) with bolus-tracking or fixed delay.
- Detects:
- Thoracic injuries → hemothorax, pneumothorax, aortic injury.
- Abdominal injuries → liver, spleen, kidney lacerations; bowel injury.
- Retroperitoneal hematoma, pelvic fractures with hemorrhage.
3️⃣ CT Angiography (if indicated)
- Performed if suspicion of vascular injury (carotid/vertebral arteries, aorta, extremity vessels).
- Can be added to the trauma protocol, especially for penetrating injuries.
4️⃣ Spine Imaging
- Cervical spine usually included with head CT.
- Thoracic & lumbar spine reconstructed from body CT dataset → no extra scan needed.
📊 Typical Polytrauma CT Protocol (One-stop ED)
| Region | Contrast | Purpose |
|---|---|---|
| Head | Non-contrast | Intracranial bleed, fractures |
| Cervical Spine | Non-contrast | Trauma clearance |
| Chest–Abdomen–Pelvis | Contrast (portal venous) | Thoracoabdominal organ injury, hemoperitoneum |
| Vascular CTA (optional) | Arterial phase | Carotid, vertebral, aorta, extremity vessels |
| 3D Reconstructions | Post-processing | Spine, pelvis, fractures |
🧠 Teaching Pearls
- Head → non-contrast is critical (hemorrhage can be obscured by contrast).
- Chest/Abdomen → contrast-enhanced venous phase is the backbone of trauma imaging.
- Always assess bone windows for fractures.
- Spine reconstructions should not be overlooked.
✅ Conclusion
The acute trauma CT protocol balances speed, coverage, and diagnostic accuracy. A non-contrast head + contrast-enhanced body scan forms the core, with vascular phases added selectively. Proper execution ensures no critical injury is missed in the chaotic ED setting.
