Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

Abstract

Purpose The indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI). Methods Prospective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square). Results 1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regions was underestimated by CI on average by an AIS of 1.9 (p < 0.001). In 22.0% of cases injury severity increased by an AIS ≥ 2 following WBCT. In 16.8% of patients additional injury findings resulted in a change of treatment (number needed to profit, NNP = 6 patients): NNP decreased from 25 for patients with an ISS < 7 up to nearly 2 for patients with an ISS > 25 at final evaluation, thereby demonstrating a significant improvement in the NNP with increasing ISS (rho = 0.33, p < 0.001). Moreover, WBCT in 88.4% of patients identified ≥ 1 incidental finding (mean 3.4) vs. 28.9% by CI only (p < 0.001). Overall, WBCT had treatment consequences in 31.9% of cases (NNP = 3.1). Conclusions The application of WBCT in addition to CI in the emergency treatment of trauma had therapy consequences for almost every third patient. On the other hand, WBCT appeared not to be indicated (ISS < 8) in at least 2/5 of patients.

Evaluation of IL-33R and Galectin-3 as New Biomarkers of Cardiac Damage after Polytrauma—Association with Cardiac Comorbidities and Risk Factors

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Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial

“…1). Fifty-four patients had to be excluded from the final analysis because of incomplete documentation (29), transfer to a non-participating hospital (9), ambulatory-only treatment (9), treatment solely at the scene (5) or death at the scene (2).…”

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Whole Body Computed Tomography for trauma patients in shock: a single centre, propensity score matched retrospective cohort study in a Swiss tertiary trauma centre

“…Although more sensitive and speci c than ultrasound and radiographs for identifying traumatic injuries [12], WBCT is currently not recommended in case of haemodynamic instability, to avoid circulatory arrest from ongoing bleeding during its more time-consuming image acquisition phase. With advanced techniques and faster WBCT protocols, this "dogma" has been repeatedly challenged.…”