Comparison of whole-body computed tomography vs selective radiological imaging on outcomes in major trauma patients: a meta-analysis

Abstract

IntroductionThe purpose of this meta-analysis was to explore the value of whole-body computed tomography (WBCT) in major trauma patients (MTPs).MethodsA comprehensive search for articles from Jan 1, 1980 to Dec 31, 2013 was conducted through PubMed, Cochrane Library database, China biology medical literature database, Web of knowledge, ProQuest, EBSCO, OvidSP, and ClinicalTrials.gov. Studies which compared whole-body CT with conventional imaging protocol (X-ray of the pelvis and chest, trans-abdominal sonography, and/or selective CT) in MTPs were eligible. The primary endpoint was all-cause mortality. The second endpoints included: time spent in the emergency department (ED), the duration of mechanical ventilation, ICU and hospital length of stay (LOS), the incidence of Multiple Organ Dysfunction Syndrome (MODS) /Multiple Organ Failure (MOF). Analysis was performed with Review Manager 5.2.10 and Stata 12.0.ResultsEleven trials enrolling 26371 patients were analyzed. In MTPs, the application of WBCT was associated with lower mortality rate (pooled OR: 0.66, 95% CI: 0.52 to 0.85) and a shorter stay in the ED (weighted mean difference (WMD), −27.58 min; 95% CI, −43.04 to −12.12]. There was no effect of WBCT on the length of ICU stay (WMD, 0.95 days; 95% CI: −0.08 to 1.98) and the length of hospital stay (WMD, 0.56 days; 95% CI: −0.03 to 1.15). Patients in the WBCT group had a longer duration of mechanical ventilation (WMD, 0.96 days, 95% CI: 0.32 to 1.61) and higher incidence of MODS/MOF (OR, 1.44, 95% CI: 1.35-1.54; P = 0.00001).ConclusionsThe present meta-analysis suggests that the application of whole-body CT significantly reduces the mortality rate of MTPs and markedly reduces the time spent in the emergency department.

Prevalence and Diagnostic Performance of Isolated and Combined NEXUS Chest CT Decision Criteria

“…We must emphasize that although we enrolled all patients with blunt trauma, our DIs and assistive information for selective CT are primarily meant for use in the hemodynamically stable blunt trauma patient, in whom there is time to obtain and interpret a CXR. Several investigators have reported that major, polytrauma patients benefit from head‐to‐pelvis CT—we do not recommend use of our DIs in these critically ill patients …”

Gunshot Injury Of Head And Neck Region With An Atypical Bullet Trajectory: The Importance Of Whole Body Computed Tomography Scan

“…WBCT scan has become a standard protocol and strongly recommended as a diagnostic method in patients with major trauma. [6][7][8] Patients who have sustained penetrating trauma and are hemodynamically unstable are usually taken to operation. In planning surgery, entrance and exit holes of the bullet, trajectory of the injury, and exploration of the wounds are the basic predictors; nevertheless, preoperative computed tomography (CT) scans may also be a helpful guide while considering the hemodynamics of patient.…”

Comparative Effectiveness Research: Alternatives to “Traditional” Computed Tomography Use in the Acute Care Setting

“…A recent meta‐analysis found no conclusive evidence of a mortality benefit, although ED length of stay was reduced, and the authors concluded that they “… eagerly await the results of randomized clinical trials. Data on cost and radiation exposure will be needed before definitive conclusions can be made.” Alternatively, some studies outside of the United States, including a recent meta‐analysis, have demonstrated a mortality benefit, although there are significant flaws in study design, particularly in the adjustment for injury severity . Patients in these positive studies were included if they had significantly altered mental status and/or high injury severity scores, which represents a relatively small subset of all trauma patients.…”