Full-Body X-Ray Imaging to Facilitate Triage: A Potential Aid in High-Volume Emergency Departments

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol—the Johannesburg trauma protocol—that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily. 1. Introduction Low- and middle-income countries account for more than 90% of global deaths from injuries. Amongst these countries is South Africa which experiences a uniquely high and violent rate of trauma. Well-documented data on the exact numbers of injuries, deaths and the underlying causes are lacking. However, some figures suggest trauma loads of between 16,？357 and 24,？113 on primary (Level 1) Trauma Centres per year [1–3]. Nationally, 46% of these are attributed to homicides, 26.7% to road traffic accidents (RTA), and 9.1% to self-inflicted injury. The homicide rate alone is nine times greater than the global average [4]. Coupled with this significantly high rate of trauma is the severe lack of resources and staffing. South Africa’s history of apartheid has left a legacy of oversubscribed, underfunded, and poorly equipped state hospitals, dealing with more than 80% of the population’s health requirements with just 25% of total healthcare expenditure [5]. Funding restrictions, together with the harsh working environment, also result in a severe shortage of adequately trained emergency staff. In South Africa, the doctor to nurse ratio is twice that for Canada and almost five times that for Israel. Possibly more disturbing, South Africa has more than four times fewer doctors per 100,？000 population than countries like Canada and Australia [6]. The two effects—high patient volumes and low resource availability—often combine to create almost warfare-like trauma situations in South African emergency departments (EDs) [7]. In response, some unique trauma mechanisms have been adopted. Among these are greater reliance on a first principles diagnostic approach and a unique triage scoring system to assist with resource