At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.
Reducing the number of unnecessary CT scans would be in the best interest of patients and physicians for several reasons:
What is the SCRAP Rule?
If all five variables below are normal, you do not need chest CT. If any one variable is positive, you may need a chest CT.
Currently, there are no accepted guidelines that aid physicians in determining which patients are at low risk for major thoracic injury in blunt trauma. Published results reveal that approximately half of the thoracic CT scans performed in blunt trauma are negative for major thoracic injury.
“Selective Scanning” as opposed to “Pan Scanning” in blunt trauma patients, is an interesting clinical concept, but the SCRAP Rule still needs a prospective, multicenter external validation before implementation into the clinical setting.
Payrastre J et al. The SCRAP Rule: The Derivation and Internal Validation of a Clinical Decision Rule for Computed Tomography of the Chest in Blunt Thoracic Trauma. CJEM 2012; 14(6): 344-53. PMID: 23131481