Analysis of the Role of Computerised Tomography in the Management of War Injuries, the Ziv Medical Center Experience


Saher Srour 1,2 Nadav Cohen 1,2 Seema Biswas 1,2
1Radiology- MRI unit, Ziv Medical Center, Israel
2Radiology, The Azreili Faculty Of Medicine, Bar Ilan University, Israel

PURPOSE: In this study we seek to evaluate the use of computerized tomography (CT) and the impact on diagnosis, management and prognosis in patients injured in the Syrian civil war treated in Ziv Medical Center in 2014.

METHODS AND MATERIALS: Retrospective analysis of indications, timing, and number of CT scans performed was correlated with clinic management, progress and outcome.

RESULTS: Of 220 patients, one patient with massive limb injury and hemorrhage was taken directly to the operating room without CT. Contrast CT was performed in 132 patients at the ER.

Ninety-five patients underwent CT within 1 hour of arrival. Of these patients 33 had abdominal, 46 chest, 24 pelvic, and 46 limb injuries. Fifty-six patients were operated within 24 hours. Thirty-seven patients underwent CT after 1 hour (11 abdominal, 12 chest, 8 pelvic, 6 limb injuries).

Mean time to surgery was 12 hours. 48 patients with orthopedic injuries underwent CT. Associated vascular injuries were found in 8 (all of which required surgical intervention). The average waiting time to the first surgery was shorter in those who have had a CT exam upon admission, compared to those who didn`t (9.2 hours vs. 16.2 hours p<0.05). Hospital staying duration was also shown to be significantly longer in those who have had more than one CT scan (average 44 days) compared to those who had only one CT scan (average 14 days) p<0.05).

Hospital staying duration was also shown to be significantly longer in those who have had more than one CT scan (average 44 days) compared to those who had only one CT scan (average 14 days) p<0.01.

CONCLUSION: CT scan revealed more than 50% additional injuries in the: Head, neck, Chest, and abdomen and pelvis when compared to physical exam alone. However in the extremity injuries there was no additional effect of the CT exam compared to physical exam. CT scan helped shorten the time interval to surgery, and had a prognostic value by helping estimation of total duration of hospital staying.

SAHER SROUR
SAHER SROUR