Impact of whole-body computed tomographyon mortality and surgical management of severe blunt trauma

Critical Care, 06/12/2012

Diagnostic whole–body computed tomography (CT) was associated with a significant reduction in 30–day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

Methods

  • The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72hours.
  • Initial data were combined to construct a propensity score to receive whole–body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1950 patients.
  • The main endpoint was 30–day mortality.

Results

  • 1696 patients out of 1950 (87%) were given whole–body CT.
  • The crude 30–day mortality rate was 16% among whole–body CT patients and 22% among selective CT patients (p=0.02).
  • A significant reduction in the mortality risk was observed among whole–body CT patients whatever the adjustment method (OR=0.58, 95% CI: 0.34–0.99 after adjustment for baseline characteristics and post–CT treatment).
  • Compared to the TRISS predicted survival, survival significantly improved for whole–body CT patients but not for selective CT patients.
  • The pattern of early surgical and medical procedures significantly differed between the two groups.

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