Refining the criteria for immediate total-body CT after severe trauma

Treskes, Kaij; Saltzherr, Teun Peter; Edwards, Michael J.; Beuker, Benn J. A.; Lieshout, Esther M.M. Van; Hohmann, Joachim; Luitse, Jan S. K.; Beenen, Ludo F. M.; Hollmann, Markus W.; Dijkgraaf, Marcel G. W.; Goslings, J. Carel

doi:10.1007/s00330-019-06503-2

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…WBCT markedly reduces time spent in the emergency department [ 97 ] and a median 19 min from admission to CT was significantly associated with decreased mortality from exsanguination in a single-centre experience [ 98 ]. A revised set of 10 clinical criteria for immediate WBCT with a high-positive predictive value for severe injury based upon secondary analysis of REACT-2 data is shown in Table 3 [ 99 ]. Given the post hoc analysis in a subset of patients on which these data are based, these criteria may not apply to all patients, and a targeted approach may be warranted.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…Recent European guidelines recommend the use of early WBCT for the detection of the source of bleeding [9]. However, due to a gap in the evidence concerning the bene t of WBCT in all severely injured patients and concerns with potentially harmful radiation exposure [10], some authors recommend a tailored approach with selective use of WBCT in injured patients [11].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have suggested the safety of WBCT and a survival bene t in unstable trauma patients [13], [14], [15],[16], [17],[18], [19], [20]. A second analysis of the REACT-2 trial showed that WBCT led to a strong reduction in mortality in injured patients requiring emergency bleeding control interventions, but failed to demonstrate a statistical signi cance due to an underpowered study [11] [21]. However, in all these studies, the de nition of haemodynamic instability was based on vital signs (systolic blood pressure, heart rate, respiratory rate, Glasgow Coma Scale score) without physiological surrogates of shock leading to heterogeneity in the treatment effect.…”

Section: Introductionmentioning

confidence: 99%

Whole Body Computed Tomography for trauma patients in shock: a single centre, propensity score matched retrospective cohort study in a Swiss tertiary trauma centre

Hanzalova,

Bourgeat,

Demartines

et al. 2023

Preprint

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Background: Trauma is one of the leading causes of death or long-term disability. The ATLS (Advanced Trauma Life Support) approach is generally accepted as the standard of care for the initial management of severely injured patients. While WBCT (Whole Body Computed Tomography) is still considered as contraindicated in haemodynamically unstable trauma patients, there is a growing amount of data indicating the absence of harm from cross sectional imaging in this patient group. Our study aimed to compare the mortality of unstable trauma patients undergoing a WBCT during the initial workup with those who did not. Methods: Single-centre retrospective observational study based on the local trauma registry from January 2008 to June 2020. We compared the 24-hour mortality of injured patients in circulatory shock undergoing WBCT with a control group undergoing standard workup only. Shock was defined as the simultaneous presence of a systolic blood pressure < 100 mmHg, Lactate>2.2 mmol/l and Base Excess <-2 mmol/l at admission. To control for confounding, a propensity score matched analysis with conditional logistic regression for adjustment of residual confounders and a sensitivity analysis using inverse probability weighting (IPW) with and without adjustment were performed. Results: Of the 161 patients fulfilling the inclusion criteria, 132 underwent WBCT and 29 standard work-up only. In crude and matched analyses, no difference in early (24 hours) mortality was observed (WBCT, 23 (17.4%) and no-WBCT, 8 (27.6%); p=0.21). After matching and adjustment for main confounders, the odds ratio for the event of death at 24 hours in the WBCT group was 0.36 (95% CI 0.07-1.73); p=0.20. Conclusions: In the present study, WBCT did not increase the risk of death at 24 hours among injured patients in shock. This adds to the growing data indicating that WBCT may be offered to trauma patients in circulatory shock without jeopardizing early survival.

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“…Each main fracture type is further subdivided into nine first-order subcategories and a total of 26 second-order subcategories [ 16 ]. Although originally designed for use with plain radiographs, the Tile classification is now routinely used based on CT images [ 17 ], which allow for a more precise evaluation of the posterior elements of the pelvic ring [ 18 – 20 ] and can further aid in identifying bleeding from pelvic sources and associated abdominal injuries [ 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons

et al. 2020

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Objectives To assess the interobserver reliability (IOR) of the Tile classification system, and its potential influence on outcomes, for the interpretation of CT images of pelvic fractures by radiologists and surgeons. Methods Retrospective data (1/2008–12/2016) from 238 patients with pelvic fractures were analyzed. Mean patient age was 44 years (SD 20); 66% were male. There were 54 Tile A, 82 Tile B, and 102 Tile C type injuries. The 30-day mortality rate was 15% (36/238). Six observers, three radiologists, and three surgeons with different levels of experience (attending/resident/intern) classified each fracture into one of the 26 second-order subcategories of the Tile classification. Weighted kappa coefficients were used to assess the IORs for the three main categories and nine first-order subcategories. Results The overall IORs of the Tile system for the main categories and first-order subcategories were moderate (kappa = 0.44) and fair (kappa = 0.31), respectively. IOR was fair to moderate among radiologists, but only fair among surgeons. By level of training, IOR was moderate between attendings and between residents, whereas it was only fair between interns. IOR was moderate to substantial (kappa = 0.56–0.70) between the radiology attending and resident. Association of the Tile fracture type with 30-day mortality was present based on two out of six observer ratings. Conclusions The overall IOR of the Tile classification system is only fair to moderate, increases with the level of rater experience and is better among radiologists than surgeons. In the light of these findings, results from studies using this classification system must be interpreted cautiously. Key Points • The overall interobserver reliability of the Tile pelvic fracture classification is only fair to moderate. • Interobserver reliability increases with observer experience and radiologists have higher kappa coefficients than surgeons. • Interobserver reliability has an impact on the association of the Tile classification system with mortality in two out of six cases.

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Refining the criteria for immediate total-body CT after severe trauma

Cited by 11 publications

References 27 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Whole Body Computed Tomography for trauma patients in shock: a single centre, propensity score matched retrospective cohort study in a Swiss tertiary trauma centre

Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons

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