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Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients

  1. Raoul Van Vugt1,*,
  2. Frederik Keus2,
  3. Digna Kool3,
  4. Jaap Deunk4,
  5. Michael Edwards1

Editorial Group: Cochrane Injuries Group

Published Online: 23 DEC 2013

Assessed as up-to-date: 9 MAY 2013

DOI: 10.1002/14651858.CD009743.pub2


How to Cite

Van Vugt R, Keus F, Kool D, Deunk J, Edwards M. Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD009743. DOI: 10.1002/14651858.CD009743.pub2.

Author Information

  1. 1

    Radboud University Nijmegen Medical Center, Department of Surgery and Trauma, Nijmegen, Netherlands

  2. 2

    University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, Netherlands

  3. 3

    Canisius Wilhelmina Hospital, Department of Radiology, Nijmegen, Netherlands

  4. 4

    VU Medical Center, Department of Surgery, Amsterdam, Brabant, Netherlands

*Raoul Van Vugt, Department of Surgery and Trauma, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, 6500 HB, Netherlands. Raoul.vanVugt@gmail.com. R.vanvugt@chir.umcn.nl.

Publication History

  1. Publication Status: New
  2. Published Online: 23 DEC 2013

SEARCH

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Deunk 2009Retrospective study (n = 50) determining the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective MDCT findings in blunt-trauma patients. All surgeons agreed that the traumatic injuries additionally found by routine MDCT frequently resulted in a change of treatment plan. There was a moderate-to-excellent agreement between and within surgeons that these additional findings resulted in a change of treatment plan

Huber-Wagner 2009Retrospective study using the German Trauma Registry to calculate a difference in predicted survival (TRISS methodology) for blunt-trauma patients with ISS > 16 in whole-body CT (n = 1494) vs. non-whole-body CT (n = 3127) between 2002 and 2004. Probability of survival significantly increased with the use of whole-body CT

Hutter 2011Retrospective cohort study of blunt-trauma comparing an era before introduction (2000-2002, n = 313) and after introduction (2002-2007, n = 608) of a liberal pan-scan. 2.7% of the variance in mortality was believed to be caused by the use of pan-CT

Okamoto 2002Prospective randomised study (n = 36) in blunt-trauma comparing incremental CT versus dynamic spiral CT after initially fluid resuscitation and plain X-ray films. Primary screening with early-phase dynamic spiral
CT for haemorrhagic multiple trauma was found to be useful for determining the applications of subsequent angiographic intervention as well as evaluating lesions caused by injury

Rieger 2009Observational study (2006, n = 88) assessing time management and diagnostic quality when using a 64-multidetector-row whole-body CT to evaluate polytraumatised patients (ISS > 18) in an emergency department

Salim 2006Prospective observational study (2004-2005) in blunt conscious multitrauma patients (n = 592) evaluating changes in treatment as a direct result of pan CT, showing that clinically significant abnormalities are not uncommon, resulting in a change in treatment in nearly 19% of patients

Sampson 2006Prospective observational study (1997-2004, n = 296) to assess the impact of the introduction of a CT for multitrauma patients on the workload, overall diagnostic yield, and effect on detection of cervical spine injury and pneumothorax. The overall impact on workload was small. A wide range of significant injuries was demonstrated rapidly, accurately and safely

Self 2013Retrospective cohort study (2000-2001) to evaluate the role of routine CT of the chest, abdomen and pelvis as a screening tool for patients (n = 457) already undergoing cranial CT studies. 38% of patients undergoing cranial CT scanning had a unexpected finding on body scans, resulting in changes in 26% of the study group

Smith 2011Retrospective cohort study (2007-2008) to evaluate changes in treatment in a period before (n = 116) and after (n = 2008) the introduction of a major trauma CT protocol, based on mechanism of injury. Substantial changes in clinical management were made in a small number of patients (2.2%) without any increase in adverse events

Stengel 2009Overview of knowledge of the value of CT, stating that diagnostic accuracy of MDCT for clearing various anatomical regions in trauma patients is, at best, unclear. Little is known about the accuracy of pan-CT as a whole, which weakens statements about its effectiveness and prevents inferences about survival advantages

Tillou 2009Prospective observational study (2007) evaluating injuries in patients with blunt-trauma (n = 284) receiving a pan-CT. Physicians were willing to omit 27% of scans. If this was done, 2 injuries requiring immediate actions would have been missed initially, and other potentially important injuries would have been missed in 17% of patients

Weninger 2007Retrospective study evaluating 2 periods in which different emergency protocols were used. First diagnostic protocol included physical examination, conventional radiography, sonography and further procedures if necessary (2001-2002, n = 185). In the second period (2003-2004, n = 185), blunt-trauma patients underwent immediate CT after admission. There was a non-significant difference in inhospital mortality (16% vs. 17%). CT in blunt major trauma leads to more accurate and faster diagnosis, and reduction of early clinical time intervals

Wurmb 2009Retrospective description of time requirement of 2 different diagnostic approaches to multiple injuries. 1 with whole-body CT as the sole radiological procedure (2004, n = 79) and 1 with conventional use of radiography, combined with abdominal ultrasound and organ focused CT (2002, n = 82). In the first, time intervals were shortened

Wurmb 2011Retrospective study comparing data of trauma patients treated with conventional trauma protocol (2001-2003, n = 155) with data from trauma patients treated with whole-body CT trauma protocol (2004-2006, n = 163). Mortality remained unchanged in both groups, time interval shortened to start emergency surgery in patients with multiple injuries undergoing whole-body CT

Yeguiayan 2012Prospective observational study (2004-2007) to assess the impact of whole-body CT (n = 1696) compared with selective CT (n = 254) on mortality and management of patients with severe blunt trauma. CT strategy was chosen by treating team or physician. Whole-body CT was associated with a significant reduction in 30-day mortality (22% vs. 16%, P value = 0.02)

 
Characteristics of ongoing studies [ordered by study ID]
REACT-2

Trial name or titleREACT 2

MethodsAn international, multicentre randomised controlled trial. All participating trauma centres have a multislice CT scanner located in the trauma room or at the emergency department. Randomisation will be computer assisted

ParticipantsAll adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded

InterventionsThe intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning

OutcomesPrimary outcome will be inhospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year after trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness

Starting date1 April 2011

Contact informationj.c.sierink@amc.nl

Notes