Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

Abstract

Purpose: The objective of this study was to evaluate the implementation of a new Single-Pass WBCT Protocol in the management of patients with severe trauma. Methods: This was an observational, prospective study of polytrauma patients who underwent WBCT. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, WBCT parameters and outcome variables were evaluated. Results: 263 patients were included. Median Injury Severity Score (ISS) was 22 (IQR: 16-22). Time between arrival to the ED and completing the WBCT was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50); p=0.96]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. RSR 85% (p=0.69); Group 2: TRISS 69% vs. RSR 74% (p=0.25); Group 3: TRISS 93% vs. RSR 87% (p=0.07)]. Conclusion: This new Single-Pass WBCT Protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

Whole-body computed tomography is safe, effective and efficient in the severely injured hemodynamically unstable trauma patient

“…Ninety-one (34%) patients required surgical management, without significant differences among groups [Group 1: 59 (35.1%); Group 2: 15 (30%); Group 3: 17 (37.7%); p = 0.23]. All patients who required surgery had positive findings during their procedure 26 . These results provide supporting evidence towards our claims that whole body computed tomography is a safe, effective and efficient tool in the initial workup and subsequent management of the severely injured trauma patient regardless of their hemodynamic status.…”

“…To this point, the inclusion of a whole body computed tomography protocol in the initial management of the severely injured trauma patient has been seen to decrease the time to definitive diagnosis, increase the accuracy of patient selection between operative vs. non-operative management, and reduce the overall radiation exposure. Therefore, whole body computed tomography has evolved worldwide to became an intrinsic component of the early diagnosis and management of the severely injured 12 , 17 , 26 .…”

“…Noventa y un (34%) pacientes requirieron manejo quirúrgico, sin diferencias significativas entre los grupos [Grupo 1: 59 (35.1%); Grupo 2: 15 (30%); Grupo 3: 17 (37.7%); p=0.23] y todos presentaron hallazgos positivos durante el procedimiento. No se encontraron diferencias significativas en cuanto a la mortalidad entre los grupos [Grupo 1: 26 (15%); Grupo 2: 13 (26%); Grupo 3: 6 (13%), p = 0.17] y ningún paciente falleció durante la realización de la tomografía corporal total 26 . Estos resultados sustentan la hipótesis central de este manuscrito de la evaluación corporal total como una herramienta de diagnóstico segura, efectiva y eficiente en la evaluación primaria y manejo de los pacientes politraumatizados sin importar su estado hemodinámico.…”

“…Por lo tanto, la inclusión de un protocolo de tomografía corporal total en el manejo inicial de pacientes politraumatizados disminuye el tiempo al diagnóstico definitivo, aumenta la precisión en la selección entre manejo operatorio y no operatorio y reduce la exposición a la radiación ionizante. De tal manera, la tomografía corporal total ha evolucionado y se ha convertido en un componente intrínseco del diagnóstico temprano y el manejo de pacientes politraumatizados alrededor del mundo 12 , 17 , 26 .…”

Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

“…Non-operative management is the gold standard for hemodynamically stable blunt splenic trauma patients with a reported rate of therapeutic failure between 4-15% [19][20][21][22] . The main complication is persistent bleeding which entails higher transfusion requirements and morbidity rates [23][24][25] .…”