Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

Abstract

IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients

“…One study 24 reported differences in ISS between the use WBCT and selective scanning as median as well as percentage of patients with ISS greater than 35. One study 28 reported differences in ISS between the use of WBCT and selective scanning as percentage of patients with ISS greater than 35. All studies reported differences in mortality rate.…”

Improving Outcomes in the Patient with Polytrauma

“…A systematic review by Healy and colleagues 26 comprising 5 nonrandomized cohort studies (4 retrospective including 1 multicenter, 1 prospective multicenter) evaluated the impact of WBCT on mortality and time spent in the ED. 24,[27][28][29][30][31] Most of the included studies reported a mortality benefit from WBCT in patients who were severely injured (based on an injury severity score [ISS] of >15) compared with selective CT. However, when the data were combined and WBCT was compared with selective CT in this meta-analysis, there was no significant reduction in mortality rate using the random effects model (OR, 0.68; 95% CI, 0.43, 1.09; P 5 .11), although the trend did suggest a potential mortality benefit.…”

Damage control interventional radiology (DCIR) in prompt and rapid endovascular strategies in trauma occasions (PRESTO): A new paradigm

“…Finally, anticipating 2 to 3 steps ahead of each and every maneuver Secondly, the patient will rapidly be transferred to the CT scanner. Although CT scanning is contra-indicated for HU patients [1], recent technological advances have largely modified the use of CT in the management of severe trauma patients and thanks to the reduced acquisition time and improved quality of imaging data, CT scan usage in the early evaluation of trauma patients has substantially increased [9]. However, state-of-the-art technology alone will not reduce procedural time but rather the combination of a trained coordinated team with a specifically designed workflow under a precise concept can only yield successful results.…”