Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma
1 Université de Bourgogne, Faculté de médecine, 21079 Dijon Cedex, France
2 Centre Hospitalier Universitaire de Dijon, Département de Médecine d'Urgence, 7 Bd Jeanne d'Arc, BP77908 21079 Dijon Cedex, France
3 Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambert, 59037 Lille Cedex, France
4 Pôle Anesthésie Réanimation, CHU de Grenoble, 38043 La Tronche cedex, France
5 Université de la Méditerranée, Centre de traumatologie et Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire Nord, Boulevard Pierre Dramard, 13015 Marseille, France
6 INSERM CIE 01, Centre d'Investigation clinique-Epidémiologique clinique du CHU de Dijon, 7 Bd Jeanne d'Arc, 21079 Dijon Cedex, France
7 Université Pierre et Marie Curie-Paris 6, Service d'Accueil des Urgences, GH Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
Critical Care 2012, 16:R101 doi:10.1186/cc11375Published: 11 June 2012
The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.
The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.
In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.
Diagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.