Whole-Body Computed Tomography May Improve Survival for Patients with Polytrauma

March 27, 2009 — For patients with polytrauma, integrating whole-body computed tomography (CT) scan into early trauma care significantly increases the probability of survival, according to the results of a retrospective, multicenter study reported in the March 24 online first issue of The Lancet.

"The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing," wrote Stefan Huber-Wagner, from Munich University Hospital in Munich, Germany, et al from the Working Group on Polytrauma of the German Trauma Society. "There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not."

The investigators used the data recorded in the trauma registry of the German Trauma Society to determine survival outcomes for 4621 patients with blunt trauma who received whole-body or non–whole-body CT. Survival probability was calculated according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardized mortality ratio (SMR, ratio of recorded to expected mortality).

Of the 4621 patients, 1494 (32%) underwent whole-body CT. Of these patients, 3364 (73%) were men. Mean age was 42.6 ± 20.7 years, and mean injury-severity score was 29.7 ± 13. Based on TRISS, SMR was 0.745 (95% confidence interval [CI], 0.633–0.859) for patients who underwent whole-body CT versus 1.023 (95% CI, 0.909–1.137) for those who underwent non–whole-body CT (P <.001).

Based on the RISC score, SMR was 0.865 (95% CI, 0.774–0.956) for patients who underwent whole-body CT versus 1.034 (95% CI, 0.959–1.109) for those who underwent non–whole-body CT (P = .017). Relative risk reduction in mortality rate based on TRISS was 25% (95% CI, 14%–37%) versus 13% (95% CI, 4%–23%) based on RISC score. Whole-body CT was an independent predictor for survival (P ≤.002), even after multivariate adjustment for hospital level, year of trauma, and potential center effects. To prevent 1 death, the number needed to scan was 17 based on TRISS and 32 based on RISC calculation.

"Integration of whole-body CT into early trauma care significantly increased the probability of survival in patients with polytrauma," the study authors wrote. "Whole-body CT is recommended as a standard diagnostic method during the early resuscitation phase for patients with polytrauma."

Limitations of this study include retrospective design; missing data in the trauma registry, allowing calculations of TRISS in only 49% and RISC score in 89% of patients; clear protocol for or against whole-body CT not clearly defined; lack of data about structural differences of the participating hospitals, such as the location of the CT scanner and transportation times between the trauma room and CT suite; lack of data about CT protocols or implementation of the principles of advanced trauma life support; potentially different intercenter consistency in grading injuries; and possible residual confounding.

"Despite these limitations, our results indicate that the probability of survival for patients with major trauma can be significantly increased by use of whole-body CT," the study authors concluded. "On the basis of our findings, we recommend that whole-body CT should be integrated into the early resuscitation phase of severely injured patients as a standard and basic diagnostic method."

Source: Medscape Medical News