Whole-body CT in blunt trauma patients and its effect on mortality
Date First Published:
March 30, 2014
Last Updated:
April 30, 2014
Report by:
Shahab Hajibandeh, MBChB (University of Liverpool)
Search checked by:
Shahin Hajibandeh, University of Liverpool
Three-Part Question:
In [blunt trauma patients] is [whole-body CT better than conventional diagnostics] in [reducing mortality]?
Clinical Scenario:
36 years old patient was transferred to emergency department following a severe blunt trauma in a road traffic accident. When deciding about initial diagnostic investigation, you wonder which one is associated with better survival: whole-body CT or conventional diagnostics.
Search Strategy:
MEDLINE using the OVID interface (1946 to February 2014) : [“whole body” OR “total body” OR “pan-ct”] AND [Mesh terms ”tomography OR X-ray computed” OR ”ct scan”] AND [trauma” OR Mesh terms ”wounds and injuries” OR “polytrauma” OR “multiple trauma”].
Search Details:
PubMed (February 2014) : [“total body” OR “whole body”] AND [ “trauma” OR “polytrauma” OR “multiple trauma”] AND [“ct” OR “computed tomography”] AND [ “mortality” OR “survival”]
Outcome:
178 articles were found in MEDLINE and 167 articles in PubMed.9 studies were relevant to the study question (Table 1).
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study. Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. 2013 Germany | 16719 adult blunt major trauma patients, ISS ≥16 |
Retrospective cohort study | Mortality rate | 17.4% in WBCT group vs 21.4% in Non-WBCT group (P value= significant, 95% CI) | Retrospective, Shows association not causality, Residual confounding effect, Lack of information about CT protocols for participating hospitals. |
| RISC-Based SMR | 0.85 (0.81–0.89) in WBCT group vs 0.98 (0.94–1.02) in non-WBCT group | ||||
| Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ. 2009 Germany | 4621 blunt trauma patients, ISS ≥16 |
Retrospective cohort study | Mortality rate | 21% in WBCT group vs 22% in Non-WBCT group (P value= Not significant, 95% CI) | Retrospective, Shows association not causality, Residual confounding effect, Lack of information about CT protocols for participating hospitals. |
| TRISS –Based SMR | 0.745 (0.633–0.859) in WBCT group vs 1.023 (0.909–1.137) in Non-WBCT group | ||||
| RISC –Based SMR | 0.865 (0.774–0.956) in WBCT group vs 1.034 (0.959–1.109) in Non-WBCT group | ||||
| Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma Yeguiayan JM, Yap A, Freysz M, Garrigue D, Jacquot C, Martin C et al 2012 France | 1950 adult severe blunt trauma patients ICU treatment |
Prospective cohort study | Mortality rate | 16% in WBCT group vs 22% in Non-WBCT group (P value= significant, 95% CI) | Shows association not causality ,Residual confounding effect ,Lack of information about CT protocols for participating hospitals. |
| Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma Wada D, Nakamori Y, Yamakawa K, Yoshikawa Y, Kiguchi T, Ogura H, et al 2013 Japan | 152 blunt trauma patients who required emergency bleeding control | Retrospective cohort study | Moratilty rate | 18.1% in WBCT group vs 80% in Non-WBCT group (P value= significant, 95% CI) | Retrospective, Shows association not causality, Small sample size in non-WBCT group, Different baseline characteristics between two groups, Residual confounding effect, Lack of pre-defined CT protocol |
| TRISS –Based SMR | 0.65 (0.41- 0.9) in WBCT group vs 1.15 (0.98-1.31) in Non-WBCT group | ||||
| Whole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study. Kimura A, Tanaka N 2013 Japan | 5208 blunt trauma patients, Systolic blood pressure >75 mmHg, GCS of 3-12 |
Retrospective cohort study | Mortality rate | 24% in WBCT group vs 28% in Non-WBCT group (P value= significant, 95% CI) | Retrospective, Shows association not causality, Residual confounding effect, Lack of information about CT protocols in participating hospitals |
| TRISS–Based SMR | 0.83 (0.75-0.91) in WBCT group vs 0.97 (0.91-1.03) in Non-WBCT group | ||||
| Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Hutter M, Woltmann A, Hierholzer C, Gartner C,Buhren V, Stengel D. 2011 Germany | 313 blunt major trauma patients | Retrospective cohort study | Mortality rate | 8% in WBCT group vs 23% in Non-WBCT group (P value= significant, 95% CI) | Retrospective, Shows association not causality, Limited sample size, Residual confounding effect |
| Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. Weninger P, MauritzW, Fridrich P, Spitaler R, Figl M, Kern B, et al. 2007 Austria | 370 blunt major trauma patients | Retrospective cohort study | Mortality rate | 17% in WBCT group vs 16% in Non-WBCT group (P value= Not significant, 95% CI) | Retrospective, Shows association not causality, Limited sample size, Residual confounding effect |
| Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma. Wurmb T E, Quaisser C, Balling H, Kredel M, Muellenbach R, Kenn W, et al. 2010 Germany | 318 blunt and penetrating trauma patients | Retrospective cohort study | Mortality rate | 8.6% in WBCT group vs 9.0% in Non-WBCT group (P value= Not significant, 95% CI) | Retrospective, Shows association not causality, Limited sample size, Residual confounding effect |
| Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival Kanz KG, Paul AO, Lefering R, Kay MV, Kreimeier U, Linsenmaier U, et al. 2010 Germany | 4817 major trauma patients, ISS ≥16 or ICU treatment |
Retrospective cohort study | Mortality rate | 18.8% in WBCT group vs 22.0% in Non-WBCT group (P value= Not significant, 95% CI) | Retrospective, Shows association not causality, Residual confounding effect, Lack of information about CT protocols in participating hospitals |
| TRISS–Based SMR | 0.74 (0.40-1.08) in WBCT group vs 0.92 (0.84-1.01) in Non-WBCT group | ||||
| RISC-Based SMR | 0.69 (0.47-0.92) in WBCT group vs 0.995 (0.94-1.06) in Non-WBCT group |
Author Commentary:
Based on the available evidences, it can be argued that use of Whole-body CT (WBCT) in trauma patients is associated with better survival outcomes compared to conventional diagnostics. However, most of the available evidences are from retrospective studies with varying quality and there has been only one prospective study. There is a need for high quality randomised controlled trials with (24-h or in-hospital) mortality as outcome of interest to provide more robust evidences about use of WBCT in trauma patients and to describe a causal relationship between WBCT and mortality in trauma patients.
Bottom Line:
Based on available best evidences, use of whole-body CT in management of blunt trauma patients appears to be associated with better survival compared to conventional diagnostics.
References:
- Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. . Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study.
- Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ.. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.
- Yeguiayan JM, Yap A, Freysz M, Garrigue D, Jacquot C, Martin C et al. Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma
- Wada D, Nakamori Y, Yamakawa K, Yoshikawa Y, Kiguchi T, Ogura H, et al. Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma
- Kimura A, Tanaka N. Whole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study.
- Hutter M, Woltmann A, Hierholzer C, Gartner C,Buhren V, Stengel D. . Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study.
- Weninger P, MauritzW, Fridrich P, Spitaler R, Figl M, Kern B, et al.. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center.
- Wurmb T E, Quaisser C, Balling H, Kredel M, Muellenbach R, Kenn W, et al. . Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma.
- Kanz KG, Paul AO, Lefering R, Kay MV, Kreimeier U, Linsenmaier U, et al.. Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival