Synopsis
Choose trauma imaging according to physiology, mechanism and patient group, obtain actionable studies without delaying resuscitation, and convert every result into an owned treatment decision.
- Settle the destination during the primary survey: unstable non-responder to haemorrhage control, suitable responder to CT, and isolated stable injury to selective imaging.
- For adults with blunt major trauma and suspected multiple injuries, NICE recommends immediate whole-body CT from vertex to mid-thigh without repositioning during acquisition.
- Do not routinely use whole-body CT in children; image the body regions indicated by clinical assessment, using paediatric protocols and senior radiology input.
- Use chest or pelvic radiography and eFAST in an unstable patient only when the result will direct immediate intervention; negative bedside studies are not definitive exclusion tests.
- Plan intravenous contrast phase and any CT angiography with the radiologist from suspected vascular, organ and urinary injury rather than adding delayed phases indiscriminately.
- Pregnancy should prompt optimisation and documentation, not cancellation of necessary maternal imaging; maternal survival is the best immediate fetal intervention.
- Do not remove spinal protection or perform repeated limb movement merely to obtain images; secure tubes, drains, binder and monitoring before transfer.
- Review images and preliminary report promptly, then acknowledge the final report and assign ownership for every acute and incidental finding.
Key red flags
Persistent or recurrent shock despite blood, active external loss or a clinical chest emergency makes routine transport to CT unsafe unless imaging occurs within a fully capable resuscitation environment.
A normal plain film, negative eFAST or benign early examination does not exclude retroperitoneal, hollow-viscus, vascular, spinal or intracranial injury after high-energy trauma.
Pregnancy, childhood and frailty modify radiation decisions, but none justifies withholding imaging that is necessary to diagnose an immediate maternal, neurological or haemorrhagic threat.
Investigation priorities
Define multisystem blunt injury in one coordinated acquisition.
Evaluate a stable suspected isolated fracture or joint injury.
Management branches
The primary survey identifies possible major injury requiring imaging or immediate control.
- Treat airway obstruction, tension pneumothorax and external catastrophic bleeding first, start blood resuscitation and assess response over time.
- For persistent non-response, use clinical and focused bedside findings to choose operative, endovascular or hybrid source control without routine CT delay.
- For a stable or sufficient responder, define whether injuries are multisystem or isolated and discuss acquisition and contrast with radiology.
- Secure airway devices, drains, access, monitoring, warming and escort capability before leaving the resuscitation area.