Scintigraphy for the diagnosis of primary unrecognised fractures in multiple trauma patients - a prospective, blinded, monocentric study.

Introduction: After structured (S3 guideline, ATLS^®) acute care of multiple trauma patients in trauma centers, post-acute missed injuries continue to occur with incidence rates ranging from 1.3 to 39% as described in literature. The aim of the tertiary survey was the reduction of these rates. However, high numbers of missed injuries continue to be reported. The aim of this prospective, single-center, blinded clinical diagnostic study was to determine whether the standardised use of 3-phase whole-body skeletal scintigraphy in severely injured patients can reduce the number of missed injuries compared with the established standard procedure for polytrauma diagnosis.

Methods: 26 patients aged 18 years or older (median 53.5 years, 4 female, 22 male) with an ISS ≥ 9 were evaluated by an orthopaedic and trauma surgeon using skeletal scintigraphy after completion of standardised trauma room diagnostics and tertiary survey, a median of 7 days after trauma. All clinical and diagnostic examinations were then analysed and a final consensus was reached on the bony injuries. An evaluation of each procedure against the consensus was performed for the whole body and five body regions.

Results: Skeletal scintigraphy was clearly superior to the established method (sensitivity 98.8% vs. 75.4%). Of the 60 additional bony injuries identified, 25 were treated without therapeutic consequences. Twenty-nine were treated conservatively without additional immobilisation and five with additional immobilisation. One unnecessary immobilisation was ended and no surgical treatment was required.

Conclusion: Three-phase whole-body skeletal scintigraphy is a low-risk, highly sensitive tool for reducing the incidence of missed injuries. A more liberal indication for skeletal scintigraphy should be given for injuries of increasing severity and in persons with impaired consciousness or paralysis, to avoid sequelae of missed injuries.

Clinical trial registration: The study was registered at the German Clinical Trails Register (DRKS) with the identifier DRKS00029402.