Systematic review and meta-analysis of whole-body computed tomography compared to conventional radiological procedures of trauma patients

Arruzza, Elio; Chau, Minh; Dizon, Janine Margarita

doi:10.1016/j.ejrad.2020.109099

Cited by 15 publications

(19 citation statements)

References 36 publications

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“…Seven SRs reported the overall mortality outcome [ 29 – 35 ], and one SR did not report any results because it did not include any eligible study [ 36 ]. The CCA showed a very high overlapping of citation primary studies (33%, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Two SRs with a very high overlapping of citation primary studies (42.86%) reported mortality at 24 h with discordant results: one SR showed statistically significant results favouring routine WBCT and the other no difference between groups [ 29 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three SRs investigated ICU LOS [ 29 , 31 , 34 ] with a very high overlapping of citation primary studies (27.78%). There are no differences between routine WBCT and non-routine WBCT in two SRs [ 29 , 31 ], whereas non-routine WBCT was effective compared to routine WBCT for reducing ICU LOS in one SR [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two SRs investigated complications, reported as MODS or MOF [ 29 , 31 ], with a very high overlapping of citation primary studies (50%). With concordant results, there are no differences between routine WBCT and non-routine WBCT in both SRs [ 29 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four SRs reported the hospital LOS [ 29 , 31 , 33 , 34 ] with very high overlapping of citation primary studies (20.83%). No differences between routine WBCT and non-routine WBCT were reported in all SRs except for one SR [ 34 ] reporting non-routine WBCT as more effective than routine WBCT to reduce hospital LOS.…”

Section: Resultsmentioning

confidence: 99%

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Structured approach with primary and secondary survey for major trauma care: an overview of reviews

et al. 2023

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Background A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma. Methods We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30–0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence). Conclusions The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%