Imaging utilization during explosive multiple casualty incidents

Background: Emergency radiology is a vital tool in the evaluation of victims of explosive multiple casualty incidents (MCIs). Prior reports estimate that approximately 50% of explosive MCI patients required imaging, including 7% to 22% who required computed tomography (CT) studies. This report describes the contemporary utilization of emergency radiology during the evaluation of explosive MCI victims in a modern US military trauma hospital in Iraq. We hypothesized that a much higher number of patients received imaging than has been reported previously in the literature. Methods: We performed a retrospective chart review of records from 3 MCIs managed at the US Air Force Theater Hospital, Balad AB, Iraq between February and April 2008. All three incidents were the result of improvised explosive devices. Results: Overall, 50 patients had a mean Injury Severity Score of 19 and a mortality of 8%. Ninety-two percent received imaging during their emergency department evaluation, including 90% who received CT, 70% who received X-rays, and 38% who received extended focused abdominal sonography for trauma ultrasound examinations. Overall, patients had a mean of 3.5 CTs and 1.9 X-rays during their initial assessment. Of the CTs, 93% were part of a trauma pan-scan, and 49% of the CT results were clinically significant. Conclusion: These results are significantly different from previous reports and indicate that victims of explosive MCIs will require more imaging, especially CT, than previously anticipated. These data will allow improved integration of radiology staffing and resource allocation into disaster management plans designed to prepare for future explosive MCIs.