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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]?

Clinical Scenario

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.

Search Strategy

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’

Search Outcome

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

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Huber-Wagner, 2009, Germany	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

Comment(s)

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.

References

1. 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.