Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study

Abstract

Trauma is a significant cause of mortality and morbidity. It is crucial to diagnose trauma patients quickly to provide effective treatment interventions in such conditions. Whole-body computed tomography (WBCT)/pan-scan is an imaging technique that enables a faster and more efficient diagnosis for polytrauma patients. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of WBCT in diagnosing injuries in polytrauma patients. We will also assess its impact on the mortality rate and length of hospital stay among trauma centers between patients who underwent WBCT and those who did not (non-WBCT). Twenty-seven studies meeting our inclusion criteria were selected among PubMed, Scopus, Web of Science, and Google Scholar. The criteria were centered on the significance of WBCT/pan-scan application in trauma patients. Stata version 15 was used to perform statistical analysis on the data. The authors have also used I2 statistics to evaluate heterogeneity. Egger and Begg’s tests were performed to rule out any publication bias. Total of twenty-seven studies including 68,838 trauma patients with a mean age of 45.0 ± 24.7 years were selected. Motor vehicle collisions were the most common cause of blunt injuries (80.0%). Head, neck, and face injuries were diagnosed in 44% (95% CI, 0.28–0.60; I2 = 99.8%), 6% (95% CI, 0.02–0.09; I2 = 97.2%), and 9% (95% CI, 0.05–0.13; I2 = 97.1%), respectively. Chest injuries were diagnosed by WBCT in 39% (95% CI, 0.28–0.51; I2 = 99.8%), abdominal injuries in 23% (95% CI, 0.03–0.43; I2 = 99.9%) of cases, spinal injuries 19% (95% CI, 0.11–0.27; I2 = 99.4%), extremity injuries 33% (95% CI, 0.23–0.43; I2 = 99.2%), and pelvic injuries 11% (95% CI, 0.04–0.18; I2 = 97.4%). A mortality odd ratio of 0.94 (95% CI, 0.83–1.06; I2 = 40.1%) was calculated while comparing WBCT and non-WBCT groups. This systematic review and meta-analysis provide insight into the possible safety, efficacy, and efficiency of WBCT/pan-scan as a diagnostic tool for trauma patients with serious injuries, regardless of their hemodynamic status. In patients with serious injuries from trauma, whether or not there are indicators of hemodynamic instability, our recommended approach is to, wherever possible, perform a WBCT without stopping the hemostatic resuscitation. By using this technology, the optimal surgical strategy for these patients can be decided upon without causing any delays in their final care or greatly raising their radiation dose.

Oblique projections in the analysis of multislice computed tomography data in gunshot wounds

“…Ці томографи, уперше представлені 2007 року компанією Toshiba, є новим витком еволюції рентгенівської комп'ютерної томографії. Вони не тільки дозволяють отримувати зображення, але й дають можливість спостерігати фізіологічні процеси майже в реальному часі [8].…”

“…WBCT/pan-scan значно допомагає у виявленні травм у грудній клітці, черевній порожнині та голові/шиї. WBCT асоціюється з нижчим рівнем смертності, незважаючи на перебування в лікарні, що підкреслює його важливу роль у своєчасному втручанні й поліпшенні результатів лікування пацієнтів [8].…”

“…Зазвичай при вогнепальних пораненнях для визначення оптимального плану втручання або неоперативного лікування при аналізі даних МСКТ використовуються аксіальні, корональні, сагітальні та 3D-реконструкції [5][6][7][8][9][10][11].…”

“…Використання всіх інструментальних можливостей МСКТ у комплексі призводить до підвищення якості діагностики [3,8].…”

Prognostic Factors and Clinical Outcomes of Surgical Treatment of Major Thoracic Trauma

“…Approximately 20–25% of deaths in polytrauma patients are due to chest injury [ 1 ]. The most common diagnostic imaging modality in polytrauma patients is computed tomography [ 2 ], although other modalities can be used during the follow-up and for prognostication [ 3 , 4 , 5 ]. The mortality rate in patients receiving blunt chest trauma is reported to be 60% both in Europe and the United States, representing a life-threatening condition because of airway damage and cardiopulmonary impairment [ 6 ].…”