Effect on survival of whole-body CT during trauma resuscitation
2009; Elsevier BV; Volume: 374; Issue: 9685 Linguagem: Inglês
10.1016/s0140-6736(09)61324-6
ISSN1474-547X
Autores Tópico(s)Pelvic and Acetabular Injuries
ResumoStefan Huber-Wagner and colleagues1Huber-Wagner S Lefering R Qvick LM et al.Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.Lancet. 2009; 373: 1455-1461Summary Full Text Full Text PDF PubMed Scopus (608) Google Scholar report an increase in the probability of survival after use of total-body CT scanning, compared with dedicated CT, in multitrauma patients. As with other publications on total-body CT, the results seem promising, but owing to methodologically suboptimum designs, the authors suggest doing more prospective research to provide better evidence on clinical outcomes, cost effectiveness, and radiation exposure.1Huber-Wagner S Lefering R Qvick LM et al.Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.Lancet. 2009; 373: 1455-1461Summary Full Text Full Text PDF PubMed Scopus (608) Google Scholar, 2Rieger M Czermak B El AR et al.Initial clinical experience with a 64-MDCT whole-body scanner in an emergency department: better time management and diagnostic quality?.J Trauma. 2009; 66: 648-657Crossref PubMed Scopus (64) Google Scholar, 3Wurmb TE Fruhwald P Hopfner W et al.Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time.J Trauma. 2009; 66: 658-665Crossref PubMed Scopus (140) Google Scholar Because of our interest in early CT scanning4Jin PH Fung Kon Goslings JC Ponsen KJ et al.Assessment of a new trauma workflow concept implementing a sliding CT scanner in the trauma room: the effect on workup times.J Trauma. 2008; 64: 1320-1326Crossref PubMed Scopus (5) Google Scholar, 5Saltzherr TP Jin PP Fung Kon Bakker FC et al.An evaluation of a Shockroom located CT scanner: a Randomized study of Early Assessment by CT scanning in Trauma patients in the bi-located Trauma center North-West Netherlands (REACT trial).BMC Emerg Med. 2008; 8: 10Crossref PubMed Scopus (19) Google Scholar we designed a randomised controlled trial in which we will compare immediate total-body CT without previous conventional radiography with dedicated CT after conventional radiography. Since retrospectively calculated trauma scores (eg, the injury severity score) cannot be used in daily practice, inclusion criteria are based on vital signs and injury pattern. This design also provides an assessment of potential overtriage that could result in unnecessary radiation exposure. To ensure maximum patient safety, participating hospitals are required to have a CT scanner, resuscitation possibilities, and conventional imaging equipment in the trauma room. To include the required 1078 patients (power calculation based on 30-day mortality), we have contacted several European trauma centres. Unfortunately, few hospitals have the facilities described above. Centres meeting the requirements had already adjusted their protocols and were not willing to randomise patients to the standard imaging strategy. Randomised trials produce the best evidence. We call for international collaboration in multicentre randomised controlled trials in order to obtain the required level of evidence for implementation of this diagnostic strategy. The REACT 2 study group consists of: T P Saltzherr, K J Ponsen, J S K Luitse, L F M Beenen, C P Henny, M W Hollmann, M G W Dijkgraaf, J B Reitsma, and J C Goslings. We declare that we have no conflicts of interest. Effect on survival of whole-body CT during trauma resuscitation – Authors' replyWe agree with Frank Andersohn that immortal time bias could have affected our study. He is right in stating that patients who received whole-body CT had to survive until the procedure was done. However, as stated in the results, only 22% of patients in the non-whole-body CT group received no CT at all. This means that 78% did receive some form of dedicated-organ CT, so in fact most of the patients in the non-whole-body CT group also had to survive until selective-organ CT. Full-Text PDF
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