Dr Stefan Huber-Wagner MD a , Rolf Lefering PhD b, Lars-Mikael Qvick MD a, Markus Körner MD c, Michael V Kay a, Prof Klaus-Jürgen Pfeifer PhD c, Prof Maximilian Reiser PhD c, Prof Wolf Mutschler PhD a, Karl-Georg Kanz PhD a, on behalf of the Working Group on Polytrauma of the German Trauma Society‡
Summary
Background
The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not.
Methods
In a retrospective, multicentre study, we used the 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 standardised mortality ratio (SMR, ratio of recorded to expected mortality) for 4621 patients with blunt trauma given whole-body or non-whole-body CT.
Findings
1494 (32%) of 4621 patients were given whole-body CT. Mean age was 42·6 years (SD 20·7), 3364 (73%) were men, and mean injury-severity score was 29·7 (13·0). SMR based on TRISS was 0·745 (95% CI 0·633-0·859) for patients given whole-body CT versus 1·023 (0·909-1·137) for those given non-whole-body CT (p<0·001). SMR based on the RISC score was 0·865 (0·774-0·956) for patients given whole-body CT versus 1·034 (0·959-1·109) for those given non-whole-body CT (p=0·017). The relative reduction in mortality based on TRISS was 25% (14-37) versus 13% (4-23) based on RISC score. Multivariate adjustment for hospital level, year of trauma, and potential centre effects confirmed that whole-body CT is an independent predictor for survival (p ≤ 0·002). The number needed to scan was 17 based on TRISS and 32 based on RISC calculation.
Interpretation
Integration of whole-body CT into early trauma care significantly increased the probability of survival in patients with polytrauma. Whole-body CT is recommended as a standard diagnostic method during the early resuscitation phase for patients with polytrauma.