Akio Kimura1, Noriko Tanaka. 1. Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Hospital, Tokyo, Japan. akimura@hosp.ncgm.go.jp
Abstract
BACKGROUND: Whole-body computed tomography (WBCT) has become commonly used in the management of blunt trauma (BT) in high-income countries, but its indications are controversial. Advanced trauma life support recommends conducting head CT for traumatized patients with a Glasgow Coma Scale (GCS) score of 3 to 12. This nationwide study was conducted to verify that WBCT is also beneficial for these patients. METHODS: The Japan Trauma Data Bank (2007-2010) was used to identify BT patients with systolic blood pressure of greater than 75 mm Hg having a GCS score of 3 to 12. Because the probability of survival (Ps) by the Trauma and Injury Severity Score (TRISS) method was used for severity adjustment, 5,208 patients not lacking variables necessary for TRISS Ps calculation were analyzed. WBCT was defined as CT including all of the head, neck, chest, abdomen, and pelvis during initial trauma management, and the WBCT group was compared with patients who did not undergo CT of one or more of the body regions (non-WBCT). RESULTS: No significant difference in TRISS Ps was observed between the groups. However, the recorded mortality proportion was significantly lower (p = 0.0002) in the WBCT group (0.24; 95% confidence interval, 0.22-0.26) than in the non-WBCT group (0.28; 95% confidence interval, 0.27-0.30). CONCLUSION: In Japan, integration of WBCT into initial trauma management may decrease mortality in BT patients with a GCS score of 3 to 12 for whom head CT is indicated.
BACKGROUND: Whole-body computed tomography (WBCT) has become commonly used in the management of blunt trauma (BT) in high-income countries, but its indications are controversial. Advanced trauma life support recommends conducting head CT for traumatized patients with a Glasgow Coma Scale (GCS) score of 3 to 12. This nationwide study was conducted to verify that WBCT is also beneficial for these patients. METHODS: The Japan Trauma Data Bank (2007-2010) was used to identify BT patients with systolic blood pressure of greater than 75 mm Hg having a GCS score of 3 to 12. Because the probability of survival (Ps) by the Trauma and Injury Severity Score (TRISS) method was used for severity adjustment, 5,208 patients not lacking variables necessary for TRISS Ps calculation were analyzed. WBCT was defined as CT including all of the head, neck, chest, abdomen, and pelvis during initial trauma management, and the WBCT group was compared with patients who did not undergo CT of one or more of the body regions (non-WBCT). RESULTS: No significant difference in TRISS Ps was observed between the groups. However, the recorded mortality proportion was significantly lower (p = 0.0002) in the WBCT group (0.24; 95% confidence interval, 0.22-0.26) than in the non-WBCT group (0.28; 95% confidence interval, 0.27-0.30). CONCLUSION: In Japan, integration of WBCT into initial trauma management may decrease mortality in BT patients with a GCS score of 3 to 12 for whom head CT is indicated.
Authors: F Mück; K Wirth; M Muggenthaler; K G Kanz; U Kreimeier; D Maxien; U Linsenmeier; W Mutschler; S Wirth Journal: Unfallchirurg Date: 2016-08 Impact factor: 1.000