The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma

Abstract

We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT.Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome.Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients’ time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06–0.75, P = 0.016).Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.

Whole body computed tomography in multi trauma patients: Review of the current literature

“… 7 Different studies reported similar results except for the study by Mao et al and their findings are presented in Table 1 . 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 …”

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

“…One SR [ 29 ] including three studies investigated hospital stay cost-based parameters. Two primary studies [ 37 , 38 ] conducted in Taiwan and Europe discovered that the costs associated were not statistically significant between routine WBCT and non-routine WBCT. Particularly, data reported from a multicentre RCT showed that the hospital costs of European hospital stay were €24 967 (95% CI 21 880–28 752) for the WBCT group and €26 995 (23 326–30 908) for the standard work-up group ( p = 0.44).…”

Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology

“…In hemodynamically stable patients with suspected ab-dominal trauma and decreased mentality, abdominal CT has been reported to diagnose hidden abdominal trauma and lower the mortality rate [63,64]. Negative results on abdominal CT show very high specificity for excluding abdominal damage, shortening the hospital stay for follow-up [65].…”