Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study
Open Access
- 24 July 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (7), e68880
- https://doi.org/10.1371/journal.pone.0068880
Abstract
The current common and dogmatic opinion is that whole-body computed tomography (WBCT) should not be performed in major trauma patients in shock. We aimed to assess whether WBCT during trauma-room treatment has any effect on the mortality of severely injured patients in shock. In a retrospective multicenter cohort study involving 16719 adult blunt major trauma patients we compared the survival of patients who were in moderate, severe or no shock (systolic blood pressure 90–110,110 mmHg) at hospital admission and who received WBCT during resuscitation to those who did not. Using data derived from the 2002–2009 version of TraumaRegister®, we determined the observed and predicted mortality and calculated the standardized mortality ratio (SMR) as well as logistic regressions. 9233 (55.2%) of the 16719 patients received WBCT. The mean injury severity score was 28.8±12.1. The overall mortality rate was 17.4% (SMR = 0.85, 95%CI 0.81–0.89) for patients with WBCT and 21.4% (SMR = 0.98, 95%CI 0.94–1.02) for those without WBCT (p<0.001). 4280 (25.6%) patients were in moderate shock and 1821 (10.9%) in severe shock. The mortality rate for patients in moderate shock with WBCT was 18.1% (SMR 0.85, CI95% 0.78–0.93) compared to 22.6% (SMR 1.03, CI95% 0.94–1.12) to those without WBCT (p<0.001, p = 0.002 for the SMRs). The mortality rate for patients in severe shock with WBCT was 42.1% (SMR 0.99, CI95% 0.92–1.06) compared to 54.9% (SMR 1.10, CI95% 1.02–1.16) to those without WBCT (p<0.001, p = 0.049 for the SMRs). Adjusted logistic regression analyses showed that WBCT is an independent predictor for survival that significantly increases the chance of survival in patients in moderate shock (OR = 0.73; 95%CI 0.60–0.90, p = 0.002) as well as in severe shock (OR = 0.67; 95%CI 0.52–0.88, p = 0.004). The number needed to scan related to survival was 35 for all patients, 26 for those in moderate shock and 20 for those in severe shock. WBCT during trauma resuscitation significantly increased the survival in haemodynamically stable as well as in haemodynamically unstable major trauma patients. Thus, the application of WBCT in haemodynamically unstable severely injured patients seems to be safe, feasible and justified if performed quickly within a well-structured environment and by a well-organized trauma team.Keywords
This publication has 42 references indexed in Scilit:
- Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort studyThe Lancet, 2012
- Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt traumaCMAJ : Canadian Medical Association Journal, 2012
- Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort studyScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
- Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocolEmergency Medicine Australasia, 2011
- Initial Performance Characterization of a Clinical Noise–Suppressing Reconstruction Algorithm for MDCTAmerican Journal of Roentgenology, 2011
- Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survivalJournal of Trauma Management & Outcomes, 2010
- Whole-Body Multislice Computed Tomography as the First Line Diagnostic Tool in Patients With Multiple Injuries: The Focus on TimeJournal Of Trauma-Injury Infection and Critical Care, 2009
- Exsanguination in trauma: A review of diagnostics and treatment optionsInjury, 2009
- CT-gesteuerte Ballonokklusion der Aorta bei traumatischen abdominellen und pelvinen MassenblutungenRöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2003
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996