Swathikan Chidambaram1, En Lin Goh2, Mansoor A Khan2. 1. Department of Surgery and Trauma, Faculty of Medicine, Imperial College London, St Mary's Hospital, London, United Kingdom. Electronic address: sc3312@ic.ac.uk. 2. Department of Surgery and Trauma, Faculty of Medicine, Imperial College London, St Mary's Hospital, London, United Kingdom.
Abstract
BACKGROUND: Traumatic injury is the third leading cause of death overall. To optimize the outcomes in these patients, hospitals employ whole-body computed tomography (WBCT) imaging due to the high diagnostic yield and potential to identify missed injuries. However, this delays time-critical interventions. Currently, there is an absence of any high-level evidence to support or refute either view. We present a meta-analysis of the available literature to elucidate the efficacy of WBCT in improving the outcomes of trauma, specifically the mortality rate. METHODS: A systematic review of studies comparing WBCT and selective CT imaging in secondary survey was conducted, using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. The articles were evaluated for intervention using WBCT to reduce mortality rate, followed by subgroup analysis for other secondary measures, using Review Manager 5.3 software. RESULTS: Eleven studies of 32,207 patients were included. There were lower overall (OR=0.79; 95% CI 0.74,0.83, p<0.05) and 24h mortality rates (OR=0.72, 95% CI 0.66,0.79, p<0.05) in the WBCT cohort. Additionally, patients in the WBCT arm spent less time in the emergency room (MD=-14.81; 95% CI -17.02, -12.60, p<0.00001) and needing ventilation (MD=-2.01; 95% CI -2.41, -1.62, p<0.05) despite a higher baseline injury severity score. CONCLUSION: The analysis shows that WBCT is associated with better outcomes, including a lower overall and 24h mortality rate, however the included studies are mostly observational and show considerable heterogeneity. Further work is required to make definitive clinical recommendations for a tailored algorithm in managing trauma patients. Crown
BACKGROUND:Traumatic injury is the third leading cause of death overall. To optimize the outcomes in these patients, hospitals employ whole-body computed tomography (WBCT) imaging due to the high diagnostic yield and potential to identify missed injuries. However, this delays time-critical interventions. Currently, there is an absence of any high-level evidence to support or refute either view. We present a meta-analysis of the available literature to elucidate the efficacy of WBCT in improving the outcomes of trauma, specifically the mortality rate. METHODS: A systematic review of studies comparing WBCT and selective CT imaging in secondary survey was conducted, using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. The articles were evaluated for intervention using WBCT to reduce mortality rate, followed by subgroup analysis for other secondary measures, using Review Manager 5.3 software. RESULTS: Eleven studies of 32,207 patients were included. There were lower overall (OR=0.79; 95% CI 0.74,0.83, p<0.05) and 24h mortality rates (OR=0.72, 95% CI 0.66,0.79, p<0.05) in the WBCT cohort. Additionally, patients in the WBCT arm spent less time in the emergency room (MD=-14.81; 95% CI -17.02, -12.60, p<0.00001) and needing ventilation (MD=-2.01; 95% CI -2.41, -1.62, p<0.05) despite a higher baseline injury severity score. CONCLUSION: The analysis shows that WBCT is associated with better outcomes, including a lower overall and 24h mortality rate, however the included studies are mostly observational and show considerable heterogeneity. Further work is required to make definitive clinical recommendations for a tailored algorithm in managing traumapatients. Crown
Authors: Carlos A Ordoñez; Michael W Parra; Alfonso Holguín; Carlos García; Mónica Guzmán-Rodríguez; Natalia Padilla; Yaset Caicedo; Claudia Orlas; Alberto García; Fernando Rodríguez-Holguín; José Julián Serna; Carlos Serna Journal: Colomb Med (Cali) Date: 2020-12-30
Authors: Carlos Ordoñez; Carlos García; Michael W Parra; Edison Angamarca; Mónica Guzmán-Rodríguez; Claudia P Orlas; Juan Pablo Herrera-Escobar; Erika Rincón; Juan José Meléndez; Jose Julián Serna; Natalia Padilla; Ana Milena Del Valle; Alberto F García; Alfonso Holguín Journal: Colomb Med (Cali) Date: 2020-03-30