The clinical benefit of a follow-up thoracic CT scan regarding parenchymal lung injury and ARDS in polytraumatized patients

• Published in: Journal of critical care 2016
• Main Authors: Negrin, Lukas L., MD, MSc, Prosch, Helmut, MD, Kettner, Stephan, MD, Halat, Gabriel, MD, Heinz, Thomas, MD, Hajdu, Stefan, MD, MBA
• Format: Article
• Language: English
• Subjects: Critical Care
• ISSN: 0883-9441
• DOI: 10.1016/j.jcrc.2016.10.003

Abstract Purpose To evaluate the increase of parenchymal lung injury (PLI) volume between the initial and a follow-up CT scan and to ascertain which of the two scans was more appropriate to predict ARDS. Material and Methods From 2011 to 2015 polytraumatized patients (≥18 years; ISS ≥ 16) directly admitted to our level I trauma center were included in our prospective study if a follow-up CT scan was possible 24 to 48 hours after the trauma. PLI volume was measured using volumetric analysis. Statistical calculations were performed in order to identify patients at risk for ARDS. Results 130 patients (mean age: 41.3 years; mean ISS: 31.9) met the inclusion criteria. Median relative PLI volume was higher in the follow-up than in the initial CTs (9.65% versus 4.84%; P = .001). ARDS developed in 42 patients (32.3%). Their initial PLI volume was higher compared to those without ARDS (11.23% vs. 2.14%; P < .0001). ARDS incidence increased with increasing initial PLI volume. ROC statistics identified initial (AUC = 0.753) and follow-up relative PLI volume as a predictor for ARDS (AUC = 0.725). Conclusions CT scans performed directly after admission are sufficient to define patients at risk for ARDS. Therefore, solely the incidence of PLI does not justify a routine follow-up CT scan.