Can the use of whole-body CT be reduced in cases of kinetic-based polytrauma patients without a clinical severity criterion? A bi-center retrospective study

Abstract

ObjectiveTo identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria.To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. MethodsRetrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded.Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. ResultsMultivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3–283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30–18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66–23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13–7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94–21.27; p = 0.01).A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. ConclusionA simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.