Abstract
IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.
Highlights
The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood
Consecutive patients were recruited between December 2004 and March 2007 if they were at least 18 years old and had a severe blunt trauma defined as trauma requiring admission into an intensive care unit (ICU) within 72 hours after injury or, in the case of early death before ICU admission, trauma managed by a mobile ICU (MICU)
Our prospective study showed that initial whole-body CT was associated with a significant 30-day mortality reduction that could be related to higher detection of traumatic lesions and higher use of surgical treatment
Summary
The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. Few studies have examined the benefit of whole-body CT on mortality in patients with major trauma and these yielded conflicting results [4,5,6]. The study’s methodology, based on Trauma and Injury Severity Score (TRISS) and revised injury severity classification (RISC) approaches, is questionable because the calculation of both scores includes the Injury Severity Score (ISS) [7]. This finding may be due to a better detection of trauma lesions by whole-body CT, which increases the ISS and, the predicted mortality in this group. The lack of detailed information about in-hospital medical and surgical management did not allow the determinants of mortality reduction to be identified
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
