Whole-body CT bolsters survival hopes of polytrauma patients

Seriously injured patients have a better chance of surviving multiple trauma when they are evaluated in the emergency room with whole-body CT, according to a study of more than 4500 cases from Germany.

The number of early trauma centers that have added whole-body CT to their protocols is increasing worldwide. But little published evidence documents the procedure's impact on polytrauma patient outcomes, according to the investigative team of Dr. Stefan Huber-Wagner, a researcher at the Munich University Hospital's department of trauma surgery. The group's latest study provides clues on how the integration of whole-body CT into early trauma care can benefit these patients.

Huber-Wagner and colleagues compared the probability of survival in patients with blunt multiple trauma who underwent whole-body CT during resuscitation with those who did not. The investigators reviewed data from 4621 patients (mean age 42.6, 73% males) from several trauma centers recorded by the German Trauma Society's registry. They calculated patients' probability of survival using three different measures: the trauma and injury severity (TRISS) and revised injury severity classification (RISC) scores and the standardized mortality ratio (SMR).

The researchers found the mortality rate based on the TRISS scale for patients who underwent whole-body CT was 0.745, lower than the 1.023 rate recorded by patients who did not receive whole-body scans. Based on the RISC scale, patients who received whole-body CT scored 0.865 versus 1.034 for those who did not undergo whole-body CT.

The differences using both quantitative methods were statistically significant (p<0.001 and p = 0.017). The relative mortality risk reduction rates for whole-body CT based on the TRISS and RISC scales were 25% and 13%, respectively. The researchers published results in the April 25 issue of The Lancet.

"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," the investigators wrote in the study.

The study is an important contribution to the care of patients with multiple trauma, and it should stimulate the pursuit of further studies on the merits of whole-body CT for trauma assessment, said Dr. Timothy C. Fabian of the University of Tennessee Health Science Center in Memphis, who commented on the piece in an accompanying article.

About one in six people in the U.S. suffer traumatic injuries in car, work-related, and other accidents during their lifetimes, according to the Centers for Disease Control and Prevention. Tens of thousands die as a result of their injuries. CDC researchers claim that advances in clinical management could reduce the number of fatalities.