Three Part Question
In [patients with multiple trauma in the emergency department] is [use of non-selective whole body CT scanning] associated with [improved survival]?
A multisystem trauma victim arrives in the emergency department and the trauma team is activated. After initial resuscitation, you wonder if whole-body CT scan would benefit this patient by improving his chance of survival.
Ovid MEDLINE(R) 1950–2010 March week 2.
Ovid EMBASE 1980–2010 week 11.
exp Tomography, x-ray Computed/ AND (trauma.mp. OR exp “Wounds and Injuries”/ OR exp Multiple Trauma/) AND (exp Whole Body Imaging/ OR (whole body).mp. OR (non-selective).mp.).
Cochrane Library searched 22 March 2010.
‘trauma’ AND ‘whole body CT’
One hundred and thirty-three papers were found in Medline, 293 in Embase and 2 in the Cochrane Library. One paper was relevant to the three-part question
|Author, date and country
||Study type (level of evidence)
|4621 trauma patients from trauma registry.||Retrospective, multicentre study||Standardised mortality ratio based on TRISS||0.745 (95% CI 0.633 to 0.859) for patients given whole body CT vs 1.023 (95% CI 0.909 to 1.137) for those given non-whole body CT (p<0.001) ||Retrospective, No standardised diagnostic algorithms or CT protocols among participating institutions. Side effects of radiation were not mentioned.|
|Standardised mortality ratio based on RISC score||0.865 (95% CI 0.774 to 0.956) for patients given whole body CT vs 1.034 (95% CI 0.959 to 1.109) for those given non-whole body CT (p=0.017) |
|Survival||Whole-body CT is an independent predictor of survival. Number needed to scan was 17 based on TRISS and 32 based on RISC calculation|
Although many studies have shown that whole-body CT scanning in trauma improves time management and increases the diagnostic yield in the emergency department, there is only one study addressing the issue of mortality. This paper provides limited evidence that the whole-body CT scan in trauma improves survival, but prospective studies are required to verify this. The potentially harmful effects of the radiation must also be studied.
Clinical Bottom Line
Whole-body CT scan appears to be associated with improved survival in major trauma patients.
Level of Evidence
Level 2 - Studies considered were neither 1 or 3.
- Huber-Wagner S, Lefering R, Qvick LM, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373(9673):1408-9.