To evaluate a gunshot case in TraumaSCAN, you must first mark external wound locations on the 3D torso model. If bullet locations are known, those can also be set within the torso model.
From the Gunshot Wounds menu, select the appropriate torso
view (anterior, posterior, left or right side) for adding
an external wound prior to marking the wound's location.
(See image below).
Click on the desired location using the left mouse button. A round red marker will appear on the torso model, indicating the external wound's location.
If the external wound being placed is known to be an entry
wound or an exit wound, select the appropriate entry from
the pop-up menu. If the wound's role is unknown, leave
the default entry as-is. Click Done on the pop-up
menu to save the location selected. (See image below).
If no red marker appears after clicking on the torso, the wound location has not been set. Click Cancel on the pop-up menu, and try the steps above again.
From the Gunshot Wounds menu, select the option Place bullet
within torso. (See image below).
Since radiology reports
sometimes specify bullet locations with respect to skeletal landmarks,
the skeleton is displayed during bullet placement, and internal
anatomic structures are hidden.
The system initially displays an anterior view of the
torso. The bullet to be placed appears at the center of
the red crosshairs.(See image below).
You can change the view of the torso presented by
clicking on the appropriate option in the pop-up menu
displayed. When you select the anterior or posterior
view options from the pop-up menu, the bullet can be moved
up and down and from left to right. When you select the
right or left lateral view options from the pop-up menu,
the bullet can be moved from left to right for depth
placement within the torso.(See image below).
Note: For gunshot wound cases, TraumaSCAN-Web expects that all entry wounds have a matching exit wound or bullet. The total number of external wounds and bullets must sum to an even number. Input inconsistent with this results in an error message being displayed. This means that the system cannot be used to evaluate cases in which bullets are lodged in the torso but their locations are completely unknown.
Once the external wound locations have been marked and bullets placed, we can note observations about patient findings in the tabbed pane labeled Input patient findings. As illustrated in the screenshot below, we observe the presence of certain findings by selecting True and the absence of certain findings by selecting False. All findings for which no definitive evidence exists are left marked Unknown (the default setting). If no information on any patient findings is available, leave all entries marked Unknown.
Evaluating the patient's status takes a while, as the system
calculates the prior probabilities of injury to different
anatomic structures. Using any information provided about
patient findings, TraumaSCAN-Web next calculates posterior
probabilities of injury to different structures and lists
possible medical conditions that might arise from the patient's
injuries. Text containing information on the patient's
possible injuries and related medical conditions are displayed
in the tabbed pane labeled
View assessment of patient's condition.
(See image below).
To provide visual cues about the assessment results, in addition
to textual output, anatomic structures in the leftmost display are
color-coded based on the posterior probabilities of injury calculated
by the Bayesian network. The color-highlighting system is as follows:
The process of evaluating a stab injury case is similar to that outlined for gunshot wounds above. Please see screenshots below for an illustration.
After completing a patient injury assessment, to evaluate a new
case, mark all findings as unknown by selecting
Set all patient evidence to unknown from the
Bayesian Network Menu. (See image below).
Next, select Clear all wound/bullet entries if the
case was a gunshot case, or Clear all stab wound entries
if the case was a stab case.(See images below).
The display should revert to its original look, with all highlighting erased and all patient findings marked as unknown:
