ESR Essentials: trauma whole-body CT imaging-practice recommendations by the European Society of Emergency Radiology.

Abstract

Major trauma is a leading cause of morbidity and mortality worldwide, particularly among children and young adults, and rapid identification of life- or limb-threatening injuries through imaging is crucial. Whole-body CT (WBCT) is central in modern major trauma pathways, enabling early detection of critical findings to guide multidisciplinary decision-making. Our study suggests three evidence-based recommendations for WBCT in major trauma care. First, WBCT protocol selection should be tailored to haemodynamic status and injury mechanism rather than applied as a single universal protocol; incorporating split-bolus, dual-phase and triple-phase techniques, each offering different diagnostic strengths and trade-offs. Special considerations can apply in pregnancy, paediatric patients, and those with contrast allergy, who may require modified imaging strategies. Second, radiologists should play an active role in trauma multidisciplinary team (MDT) care, assisting in protocol adaptation and directly directing the trauma team to life-threatening injuries. Third, systematic, checklist-driven radiological reporting with defined communication pathways improves trauma diagnostics, increases reporting reproducibility and strengthens trauma decision-making. These recommendations are best implemented through locally agreed, mechanism and physiology-based WBCT protocols, supported by trauma-trained radiologists embedded in scanning processes and multidisciplinary trauma care. KEY POINTS: Whole-body CT enables rapid and comprehensive assessment of patients with major trauma and suspected multisystem injury. Radiologists play an active role in trauma team care through real-time CT assessment and early identification of life-threatening injuries. Modern trauma imaging should incorporate standardised, protocol-driven acquisition and structured image interpretation.