Andrew Mekhail, Intensive Care Registrar, Wellington Regional Hospital, NZ
Andrew Mekhail is a PGY4 registrar at Wellington Hospital who has just completed a rotation in Intensive Care Medicine with the aim of pursuing a career in surgery. He has always had an interest in trauma because of the multiple organ systems that must be managed simultaneously. One way of improving care for those presenting with traumatic injuries is the use of scoring systems to streamline imaging and treatment by mobilising appropriate medical staff and services. Andrew looks at and analyses the use of 2 different scoring tools to investigate their efficacy in the management of patients presenting with major traumatic injuries.
The Use of the “Modified MANTIS Score” in Guiding Decisions for Early Radiological Imaging with Whole Body CT for Major Trauma Presentations to Wellington Hospital
Mekhail, A., Intensive Care Registrar, Wellington Regional Hospital, New Zealand Moore, J., Head of Trauma, Intensive Care Specialist/Cardiac Anaesthetist, Wellington Regional Hospital, New Zealand
Introduction: There is a global trend towards whole body computed tomography imaging (WBCT) for major trauma presentations, following several studies demonstrating an associated survival benefit. A 2016 study from Manchester looked at major trauma presentations and developed the Manchester Trauma Imaging Score (MANTIS) – calculating the biggest predictors for multiple region injury in major trauma to guide WBCT use. The Modified MANTIS score (M-MANTIS) was created as a decision support tool for early imaging with WBCT in major trauma presentations to Wellington Hospital.
Aims: To assess if M-MANTIS scoring increases diagnostic yield of WBCT for multi-region traumatic injury, without grossly increasing WBCT usage.
Method: Data from all major trauma presentations was collected from Wellington hospital database from 1st/March/2018-1st/March/2019. Each presentation was analysed with the M-MANTIS to see if criteria was met for WBCT. The final diagnoses were then analysed for multi-region, single region or no traumatic injury.
Results: There were 206 major trauma presentations within the study period. 115 (56%) met criteria for WBCT, with 106 of those undergoing WBCT and further 2 completed for those that did not meet criteria. From 108 WBCT scans completed, 58 (54%) diagnosed injuries in ≥2 regions. Of the remaining 98 presentations, 89 (91%) did not meet criteria for WBCT. The calculated sensitivity for WBCT capturing multi-region injury was 0.89. The specificity for no or focused CT finding no or single region traumatic injury was 0.65. This shows an increase in sensitivity in diagnosing multi-region traumatic injuries with WBCT from prior to the introduction of M-MANTIS (0.55) whilst maintaining specificity (0.64).
Conclusion: Staff have largely adhered to following the M-MANTIS scoring system to guide decisions for WBCT in trauma presentations. An increase in sensitivity whilst maintaining specificity suggests an increased diagnostic yield of WBCT for multi-region trauma, without an increase in unnecessary WBCT scans.