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Improving the imaging of trauma: is evidence-based imaging the answer?

With the rapid development of modern imaging technology, a wide range of traumatic conditions can be quickly and accurately diagnosed. For example, of all emergency conditions, the multiple-trauma patient has perhaps benefited the most from helical and multislice CT in particular (1, 2). However, since the cost and utilization of imaging continues to increase, it is understandable that politicians are showing increasing interest in understanding whether imaging expenditures are justified by eventual outcome improvements. Therefore, in order to better utilize new technology, it is of utmost importance to assess the accomplishment and cost for each imaging modality. But how do we move forward? It is well known that, in trauma radiology, proven accuracy is of paramount importance when comparing different imaging modalities, and false positives are generally not as catastrophic as false negatives. But how do we determine which subjects should undergo imaging and what imaging should be applied? To answer these questions, systematic research is needed. In this issue of Acta Radiologica, Dr. C. Craig Blackmore (3) summarizes the methods of evidence-based imaging in trauma radiology; how to formulate a clinically relevant question, how to search the medical literature, critically analyze the data, and summarize the evidence, and, last but not least, how to apply the evidence to practice. The success of clinical prediction rules, such as the Ottawa Ankle, Foot and Knee Rules and the Canadian Cervical Spine Rule, as well as the NEXUS study have been able to substantially reduce the amount of unnecessary imaging. As clinical prediction rules provide the highest levels of evidence for who should undergo imaging, more research is definitely encouraged to cover the large field of trauma imaging. This paper is highly recommended reading for all radiologists working in the field of emergency and trauma radiology.