Use of whole-body CT* scans in early trauma care significantly increases the probability of survival in severely injured patients with multiple trauma (polytrauma). This is the conclusion of an Article published Online First and in an upcoming edition of The Lancet, written by Dr Stefan Huber-Wagner, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany, and colleagues.
Whilst the number of trauma centres using whole-body CT for early assessment of trauma is increasing, there is no evidence to date that the procedure has any effect on the outcome of patients with serious injuries. The authors thus compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not. They used data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardized mortality (SMR, the ratio of recorded to expected mortality). TRISS is the most widely used method for measurement of expected outcome in trauma patients, the recently developed RISC score is even more precise than TRISS. The study looked at 4621 patients from various German trauma centres, mean age 42.6 years. Of these, 73% were men, 1494 (32%) had been given whole-body CT, and the mean injury severity score (ISS)** was 29.7 — showing that the investigated patients did have critical injuries.
The researchers found that SMR based on TRISS was 0.745 for patients given whole-body CT versus 1.023 for those given non-whole-body CT. SMR based on the RISC score was 0.865 for patients given whole-body CT versus 1.034 for those given non-whole-body CT. This means that the recorded mortality rate for patients given whole-body CT is significantly lower than predicted with TRISS and RISC-score. The relative risk reduction in mortality for whole-body CT based on TRISS was 25% and 13% based on RISC. Data adjustment confirmed whole-body CT as an independent predictor of survival.
The authors conclude: "Integration of whole-body CT into early trauma care significantly increased the probability of survival in patients with polytrauma... On the basis of our findings, we recommend that whole-body CT should be integrated into the early resuscitation phase of severely injured patients as a standard and basic diagnostic method."
In an accompanying Comment, Dr Timothy C Fabian, University of Tennessee Health Science Center, Memphis, TN, USA, describes the work as an important contribution to the care of patients with multiple trauma. He concludes: "I do not believe that health-care cost is a substantial concern with whole-body CT. Overall, today's study should stimulate the pursuit of further investigations on the usefulness of whole-body CT for trauma assessment."
Dr Stefan Huber-Wagner, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany T) +49-89-5160-2511 E) stefan.huber@med.uni-muenchen.de
Dr Timothy C Fabian, University of Tennessee Health Science Center, Memphis, TN, USA T) +1 901-581-0114 / +1 901-448-5914 E) tfabian@utmem.edu
For full Article and Comment see: http://press.thelancet.com/wholebodyct.pdf
Notes to editors: *CT=computed tomography
** The injury severity score (ISS) is a widely used and standard tool for the grading of the injury severity, well known to experts and people dealing with trauma. It ranges from 0-75, with 0 = no injury and 75= death (for example decapitation, non-survivable injury). A fracture of the femur, for example makes an ISS of 9. An ISS of ≥16 (16-75) represents a severely injured patient.
Journal
The Lancet