Abstract
BackgroundComputed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients.Methods/designThe REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness.DiscussionThe REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group.Trial RegistrationClinicalTrials.gov: (NCT01523626).
Highlights
Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy
Guidelines which include a fast and priority-based physical examination as well as screening radiographs supplemented with selective Computed Tomography (CT) [3]
When a patient arrives in the trauma room a brief report of the pre-hospital circumstances, medical assessment and clinically suspected injuries is presented to the trauma team leader by the ambulance personnel
Summary
Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. Literature provides limited evidence whether immediate total-body CT leads to better clinical outcome conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. Injuries are the cause of 5.8 million deaths annually which accounts for almost 10% of global mortality [1]. Whether unintentional or Specialized trauma centers all over the world provide initial trauma care and diagnostic work-up of trauma patients. Guidelines which include a fast and priority-based physical examination as well as screening radiographs supplemented with selective Computed Tomography (CT) [3]. ATLS guidelines advise to routinely perform X-rays of thorax and pelvis and Focused Assessment with Sonography for Tauma (FAST) in trauma patients. Whether or not to perform CT scanning following conventional imaging is defined less clearly in the ATLS guidelines and depends upon national guidelines and local protocols
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