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European Radiology
Published in: European Radiology 5/2020

Open Access 01-05-2020 | Computed Tomography | Emergency Radiology

Refining the criteria for immediate total-body CT after severe trauma

Authors: Kaij Treskes, Teun P. Saltzherr, Michael J. R. Edwards, Benn J. A. Beuker, Esther M. M. Van Lieshout, Joachim Hohmann, Jan S. K. Luitse, Ludo F. M. Beenen, Markus W. Hollmann, Marcel G. W. Dijkgraaf, J. Carel Goslings, on behalf of the REACT-2 study group

Published in: European Radiology | Issue 5/2020

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Abstract

Objectives

Initial trauma care could potentially be improved when conventional imaging and selective CT scanning is omitted and replaced by immediate total-body CT (iTBCT) scanning. Because of the potentially increased radiation exposure by this diagnostic approach, proper selection of the severely injured patients is mandatory.

Methods

In the REACT-2 trial, severe trauma patients were randomized to iTBCT or conventional imaging and selective CT based on predefined criteria regarding compromised vital parameters, clinical suspicion of severe injuries, or high-risk trauma mechanisms in five trauma centers. By logistic regression analysis with backward selection on the 15 study inclusion criteria, a revised set of criteria was derived and subsequently tested for prediction of severe injury and shifts in radiation exposure.

Results

In total, 1083 patients were enrolled with median ISS of 20 (IQR 9–29) and median GCS of 13 (IQR 3–15). Backward logistic regression resulted in a revised set consisting of nine original and one adjusted criteria. Positive predictive value improved from 76% (95% CI 74–79%) to 82% (95% CI 80–85%). Sensitivity decreased by 9% (95% CI 7–11%). The area under the receiver operating characteristics curve remained equal and was 0.80 (95% CI 0.77–0.83), original set 0.80 (95% CI 0.77–0.83). The revised set retains 8.78 mSv (95% CI 6.01–11.56) for 36% of the non-severely injured patients.

Conclusions

Selection criteria for iTBCT can be reduced from 15 to 10 clinically criteria. This improves the positive predictive value for severe injury and reduces radiation exposure for less severely injured patients.

Key Points

• Selection criteria for iTBCT can be reduced to 10 clinically useful criteria.
• This reduces radiation exposure in 36% of less severely injured patients.
• Overall discriminative capacity for selection of severely injured patients remained equal.
Appendix
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Metadata
Title
Refining the criteria for immediate total-body CT after severe trauma
Authors
Kaij Treskes
Teun P. Saltzherr
Michael J. R. Edwards
Benn J. A. Beuker
Esther M. M. Van Lieshout
Joachim Hohmann
Jan S. K. Luitse
Ludo F. M. Beenen
Markus W. Hollmann
Marcel G. W. Dijkgraaf
J. Carel Goslings
on behalf of the REACT-2 study group
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06503-2

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