Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study

Abstract

IntroductionSingle-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in the early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an indicator of enhanced process quality of emergency care that may lead to improved survival regardless of the actual use of the method.MethodsThis retrospective cohort study included consecutive patients with blunt trauma referred to a trauma center prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The overall mortality between the two periods was compared and stratified according to the availability and actual use of the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and injury-related independent variables.ResultsThe study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of the pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality was 23.3, 14.8 and 7.9% (P < 0.001), respectively. By univariable logistic regression analysis, both the availability (odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95% CI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the Glasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained variance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest injury severity quartile.ConclusionsIn this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of the pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently moderate and needs further investigation with regard to the diagnostic yield and changes in management decisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, ISRCTN35424832 and ISRCTN41462125)

Retrospective Analysis of Whole-Body Multislice Computed Tomography Findings Taken in Trauma Patients

“…19 In addition, the duration of hospital stay is reportedly shorter in MSCT protocols. 19,20 Hutter et al reported a mortality rate of 23.3% in MSCT protocol and 9.7% in conventional CT protocol. 20 In a study by Gupta et al 1812 of 2804 imaging procedures were considered necessary by both emergency physicians and trauma surgeons and a critical pathology was detected in 123 (7%) imaging procedures.…”

“…19,20 Hutter et al reported a mortality rate of 23.3% in MSCT protocol and 9.7% in conventional CT protocol. 20 In a study by Gupta et al 1812 of 2804 imaging procedures were considered necessary by both emergency physicians and trauma surgeons and a critical pathology was detected in 123 (7%) imaging procedures. They concluded that CT had an important role for treatment planning, mortality, and morbidity in multitrauma patients.…”

Complementary exams in blunt torso trauma. Perform only radiographs and fast: is it safe?

“…In addition, lower doses of radiation should be considered, especially in children and the young. Although there are no Brazilian data on the subject, it is estimated that, in the United States, between 1.5 and 2% of all diagnosed neoplasms are related to hospital radiation use 5 . Such data is relevant to this discussion, since full-body CT scans generate a radiation dose of 10-30mSv 6,8,[11][12][13][14][15] , which is up to 1,000 times greater than that of a PA chest X-ray, whose estimated dose is 0.01mSv 16 .…”

“…There are other issues in literature that reinforce the safety of the conduct of cases through conventional studies, leaving the CT as an supplementary examination. Firstly, the effectiveness of the reduction in mortality by way ofa full-body CT scan during initial evaluation remains uncertain in literature [4][5][6][7][8][9] . There is a lack of important randomized and controlled studies on the subject and there are articles that do not show an associated reduction in mortality 4 .…”

Ocorrência de traumatismo raquidiano em doentes em coma decorrente de traumatismo cranioencefálico

“…(Harris et al, 2008Holly et al, 2001Martins et al, 2003;Cristante e Jorge, 2012;Lutaka et al, 2012 ;Marcon et al, 2012;Miller et al, 2010;Schmidt et al, 2009;Rosi, 2011 (Kattail et al, 2009;Hunter et al, 2011;Maurer et al, 2009;Mulligan et al, 2010;Schmidt et al, 2009;Sampson et al, 2006;Sun et al, 2010).…”