Abstract
PurposeThe indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI).MethodsProspective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square).Results1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regions was underestimated by CI on average by an AIS of 1.9 (p < 0.001). In 22.0% of cases injury severity increased by an AIS ≥ 2 following WBCT. In 16.8% of patients additional injury findings resulted in a change of treatment (number needed to profit, NNP = 6 patients): NNP decreased from 25 for patients with an ISS < 7 up to nearly 2 for patients with an ISS > 25 at final evaluation, thereby demonstrating a significant improvement in the NNP with increasing ISS (rho = 0.33, p < 0.001). Moreover, WBCT in 88.4% of patients identified ≥ 1 incidental finding (mean 3.4) vs. 28.9% by CI only (p < 0.001). Overall, WBCT had treatment consequences in 31.9% of cases (NNP = 3.1).ConclusionsThe application of WBCT in addition to CI in the emergency treatment of trauma had therapy consequences for almost every third patient. On the other hand, WBCT appeared not to be indicated (ISS < 8) in at least 2/5 of patients.
Highlights
Suspected major trauma requires urgent diagnostics, often followed by immediate lifesaving interventions
Comparing whole body computed tomography (WBCT) vs. conventional imaging (CI) as defined according to equivalent body regions revealed that significantly more injury findings and more severe injuries were detected by WBCT (Table 2)
The evaluation yielded three major findings: First, the routine use of WBCT resulted in significant information gain in comparison to single as well as ‘complete CI’, valid for both, injury and incidental findings: In almost every second patient at least one finding was missed by CI only
Summary
Suspected major trauma requires urgent diagnostics, often followed by immediate lifesaving interventions. To commence appropriate emergency treatment, a straightforward and complete assessment of the injured patients is needed [1, 2]. In many trauma centres so-called ‘whole body CT’ Despite the increasing use of WBCT in the emergency room (ER) treatment of trauma, evidence is limited on the usefulness of WBCT, in less severely injured patients. The arguments pro and contra range from time saving to time loss [5, 6], risk of radiation [7, 8], obstructing direct care of the patient under treatment to possible life saving effects due to its merits as a quick and sensitive diagnostic tool [9]. No consensus exists on the indication criteria for its use, when to execute WBCT only, when to add WBCT to conventional imaging, or any combinations
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