Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014

Open Access 01-12-2014 | Original research

Comparison of whole-body computed tomography vs selective radiological imaging on outcomes in major trauma patients: a meta-analysis

Authors: Libing Jiang, Yuefeng Ma, Shouyin Jiang, Ligang Ye, Zhongjun Zheng, Yongan Xu, Mao Zhang

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2014

Login to get access

Abstract

Introduction

The purpose of this meta-analysis was to explore the value of whole-body computed tomography (WBCT) in major trauma patients (MTPs).

Methods

A comprehensive search for articles from Jan 1, 1980 to Dec 31, 2013 was conducted through PubMed, Cochrane Library database, China biology medical literature database, Web of knowledge, ProQuest, EBSCO, OvidSP, and ClinicalTrials.gov. Studies which compared whole-body CT with conventional imaging protocol (X-ray of the pelvis and chest, trans-abdominal sonography, and/or selective CT) in MTPs were eligible. The primary endpoint was all-cause mortality. The second endpoints included: time spent in the emergency department (ED), the duration of mechanical ventilation, ICU and hospital length of stay (LOS), the incidence of Multiple Organ Dysfunction Syndrome (MODS) /Multiple Organ Failure (MOF). Analysis was performed with Review Manager 5.2.10 and Stata 12.0.

Results

Eleven trials enrolling 26371 patients were analyzed. In MTPs, the application of WBCT was associated with lower mortality rate (pooled OR: 0.66, 95% CI: 0.52 to 0.85) and a shorter stay in the ED (weighted mean difference (WMD), –27.58 min; 95% CI, –43.04 to –12.12]. There was no effect of WBCT on the length of ICU stay (WMD, 0.95 days; 95% CI: –0.08 to 1.98) and the length of hospital stay (WMD, 0.56 days; 95% CI: –0.03 to 1.15). Patients in the WBCT group had a longer duration of mechanical ventilation (WMD, 0.96 days, 95% CI: 0.32 to 1.61) and higher incidence of MODS/MOF (OR, 1.44, 95% CI: 1.35-1.54; P = 0.00001).

Conclusions

The present meta-analysis suggests that the application of whole-body CT significantly reduces the mortality rate of MTPs and markedly reduces the time spent in the emergency department.
Appendix
Available only for authorised users
Literature
1.
Heron M: Deaths: leading causes for 2008. Natl Vital Stat Rep. 2012, 60 (6): 1-94.PubMed
2.
Philipp MO, Kubin K, Hormann M, Metz VM: Radiological emergency room management with emphasis on multidetector-row CT. Eur J Radiol. 2003, 48 (1): 2-4. 10.1016/S0720-048X(03)00206-7.CrossRefPubMed
3.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380 (9859): 2095-2128. 10.1016/S0140-6736(12)61728-0.CrossRefPubMed
4.
Wurmb TE, Fruhwald P, Hopfner W, Keil T, Kredel M, Brederlau J, Roewer N, Kuhnigk H: Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. J Trauma. 2009, 66 (3): 658-665. 10.1097/TA.0b013e31817de3f4.CrossRefPubMed
5.
Hoyt DB, Bulger EM, Knudson MM, Morris J, Ierardi R, Sugerman HJ, Shackford SR, Landercasper J, Winchell RJ, Jurkovich G: Death in the operating room: an analysis of a multi-center experience. J Trauma. 1994, 37 (3): 426-432. 10.1097/00005373-199409000-00016.CrossRefPubMed
6.
Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, Moore E: Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007, 21 (1): 31-37. 10.1097/BOT.0b013e31802ea951.CrossRefPubMed
7.
Martin M, Oh J, Currier H, Tai N, Beekley A, Eckert M, Holcomb J: An analysis of in-hospital deaths at a modern combat support hospital. J Trauma. 2009, 66 (4): S51-S60. 10.1097/TA.0b013e31819d86ad. discussion S60-51CrossRefPubMed
8.
Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R: Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013, 17 (2): R76-10.1186/cc12685.PubMedCentralCrossRefPubMed
9.
Postma IL, Beenen LF, Bijlsma TS, Berger FH, Heetveld MJ, Bloemers FW, Goslings JC: Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?. Eur Radiol. 2014, 24 (3): 785-791. 10.1007/s00330-013-3072-y.CrossRefPubMed
10.
Gwinnutt C: ATLS approach to trauma management. Acta Anaesthesiol Belg. 2005, 56 (4): 403.PubMed
11.
Self ML, Blake AM, Whitley M, Nadalo L, Dunn E: The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. Am J Surg. 2003, 186 (6): 609-613. 10.1016/j.amjsurg.2003.08.003. discussion 613-604CrossRefPubMed
12.
Tillou A, Gupta M, Baraff LJ, Schriger DL, Hoffman JR, Hiatt JR, Cryer HM: Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 2009, 67 (4): 779-787. 10.1097/TA.0b013e3181b5f2eb.CrossRefPubMed
13.
Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D: Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg. 2006, 141 (5): 468-473. 10.1001/archsurg.141.5.468. discussion 473-465CrossRefPubMed
14.
Watchorn J, Miles R, Moore N: The role of CT angiography in military trauma. Clin Radiol. 2013, 68 (1): 39-46. 10.1016/j.crad.2012.05.013.CrossRefPubMed
15.
Langner S, Fleck S, Kirsch M, Petrik M, Hosten N: Whole-body CT trauma imaging with adapted and optimized CT angiography of the craniocervical vessels: do we need an extra screening examination?. AJNR Am J Neuroradiol. 2008, 29 (10): 1902-1907. 10.3174/ajnr.A1261.CrossRefPubMed
16.
Atluri S, Richard HM, Shanmuganathan K: Optimizing multidetector CT for visualization of splenic vascular injury. Validation by splenic arteriography in blunt abdominal trauma patients. Emerg Radiol. 2011, 18 (4): 307-312. 10.1007/s10140-011-0961-8.CrossRefPubMed
17.
Okamoto K, Norio H, Kaneko N, Sakamoto T, Kaji T, Okada Y: Use of early-phase dynamic spiral computed tomography for the primary screening of multiple trauma. Am J Emerg Med. 2002, 20 (6): 528-534. 10.1053/ajem.2002.34802.CrossRefPubMed
18.
Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG: Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009, 373 (9673): 1455-1461. 10.1016/S0140-6736(09)60232-4.CrossRefPubMed
19.
Huber-Wagner S, Biberthaler P, Haberle S, Wierer M, Dobritz M, Rummeny E, van Griensven M, Kanz KG, Lefering R: Whole-body CT in haemodynamically unstable severely injured patients - a retrospective. multicentre study. PLoS One. 2013, 8 (7): e68880-10.1371/journal.pone.0068880.PubMedCentralCrossRefPubMed
20.
Wurmb TE, Quaisser C, Balling H, Kredel M, Muellenbach R, Kenn W, Roewer N, Brederlau J: Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma. Emerg Med J. 2011, 28 (4): 300-304. 10.1136/emj.2009.082164.CrossRefPubMed
21.
Hutter M, Woltmann A, Hierholzer C, Gartner C, Buhren V, Stengel D: Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2011, 19: 73-10.1186/1757-7241-19-73.PubMedCentralCrossRefPubMed
22.
Kanz KG, Paul AO, Lefering R, Kay MV, Kreimeier U, Linsenmaier U, Mutschler W, Huber-Wagner S: Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival. J Trauma Manag Outcomes. 2010, 4: 4-10.1186/1752-2897-4-4.PubMedCentralCrossRefPubMed
23.
Wada D, Nakamori Y, Yamakawa K, Yoshikawa Y, Kiguchi T, Ogura H, Kuwagata Y, Shimazu T, Tasaki O, Hamasaki T, Fujimi S: Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma. Crit Care. 2013, 17 (4): R178-10.1186/cc12861.PubMedCentralCrossRefPubMed
24.
Ruchholtz S, Lefering R, Paffrath T, Oestern HJ, Neugebauer E, Nast-Kolb D, Pape HC, Bouillon B: Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int. 2008, 105 (13): 225-231.PubMedCentralPubMed
25.
Sierink JC, Saltzherr TP, Wirtz MR, Streekstra GJ, Beenen LF, Goslings JC: Radiation exposure before and after the introductionof a dedicated total-body CT protocol multitrauma patients. Emerg Radiol. 2013, 20 (6): 507-512. 10.1007/s10140-013-1147-3.CrossRefPubMed
26.
Loewenhardt B, Buhl M, Gries A, Greim CA, Hellinger A, Hessmann M, Rathjen T, Reinert M, Manke C, Bernhard M: Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning. Injury. 2012, 43 (1): 67-72. 10.1016/j.injury.2011.10.014.CrossRefPubMed
27.
Snyder GE: Whole-body imaging in blunt multisystem trauma patients who were never examined. Ann Emerg Med. 2008, 52 (2): 101-103. 10.1016/j.annemergmed.2007.03.023.CrossRefPubMed
28.
Stengel D, Frank M, Matthes G, Schmucker U, Seifert J, Mutze S, Wich M, Hanson B, Giannoudis PV, Ekkernkamp A: Primary pan-computed tomography for blunt multiple trauma: can the whole be better than its parts?. Injury. 2009, 40 (Suppl 4): S36-S46. 10.1016/j.injury.2009.10.035.CrossRefPubMed
29.
Linsenmaier U, Krotz M, Hauser H, Rock C, Rieger J, Bohndorf K, Pfeifer KJ, Reiser M: Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol. 2002, 12 (7): 1728-1740. 10.1007/s00330-001-1225-x.CrossRefPubMed
30.
Sierink JC, Saltzherr TP, Reitsma JB, Van Delden OM, Luitse JS, Goslings JC: Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients. Br J Surg. 2012, 99 (Suppl 1): 52-58. 10.1002/bjs.7760.CrossRefPubMed
31.
Healy DA, Hegarty A, Feeley I, Clarke-Moloney M, Grace PA, Walsh SR: Systematic review and meta-analysis of routine total body CT compared with selective CT in trauma patients. Emerg Med J. 2013, 31 (2): 101-108. 10.1136/emermed-2012-201892.CrossRefPubMed
32.
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535.PubMedCentralCrossRefPubMed
33.
Hozo SP, Djulbegovic B, Hozo I: Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005, 5: 13-10.1186/1471-2288-5-13.PubMedCentralCrossRefPubMed
34.
DerSimonian R, Laird N: Meta-analysis in clinical trials. Contr Clin Trials. 1986, 7 (3): 177-188. 10.1016/0197-2456(86)90046-2.CrossRef
35.
Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997, 315 (7109): 629-634. 10.1136/bmj.315.7109.629.PubMedCentralCrossRefPubMed
36.
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH: GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011, 64 (4): 401-406. 10.1016/j.jclinepi.2010.07.015.CrossRefPubMed
37.
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A: GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011, 64 (4): 380-382. 10.1016/j.jclinepi.2010.09.011.CrossRefPubMed
38.
Sierink JC, Saltzherr TP, Beenen LF, Russchen MJ, Luitse JS, Dijkgraaf MG, Goslings JC: A case-matched series of immediate total-body CT scanning versus the standard radiological work-up in trauma patients. World J Surg. 2013, 38 (4): 795-802. 10.1007/s00268-013-2310-4.CrossRef
39.
Weninger P, Mauritz W, Fridrich P, Spitaler R, Figl M, Kern B, Hertz H: Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. J Trauma. 2007, 62 (3): 584-591. 10.1097/01.ta.0000221797.46249.ee.CrossRefPubMed
40.
Kimura A, Tanaka N: Whole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study. J Trauma Acute Care Surg. 2013, 75 (2): 202-206. 10.1097/TA.0b013e3182905ef7.CrossRefPubMed
41.
Yeguiayan JM, Yap A, Freysz M, Garrigue D, Jacquot C, Martin C, Binquet C, Riou B, Bonithon-Kopp C: Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma. Crit Care. 2012, 16 (3): R101-10.1186/cc11375.PubMedCentralCrossRefPubMed
42.
Zhongfu B: The value of emergent spiral CT of multiple body regions in severe mutiple trauma patients. Modern Medicine. 2011, 39 (4): 459-460.
43.
Mao Shanlin X, Xinfa XY, Hongfei W, Lijun L: The value of whole-body CT in severe traffic trauma patients during the early resuscitation phase. Chinese J Trauma. 2012, 28 (3): 269-271.
44.
Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ: Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010, 34 (1): 158-163. 10.1007/s00268-009-0266-1.CrossRefPubMed
45.
Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT: Epidemiology of trauma deaths: a reassessment. J Trauma. 1995, 38 (2): 185-193. 10.1097/00005373-199502000-00006.CrossRefPubMed
46.
Wurmb T, Balling H, Fruhwald P, Keil T, Kredel M, Meffert R, Roewer N, Brederlau J: Polytrauma management in a period of change: time analysis of new strategies for emergency room treatment. Unfallchirurg. 2009, 112 (4): 390-399. 10.1007/s00113-008-1528-3.CrossRefPubMed
47.
Hilbert P, Zur Nieden K, Hofmann GO, Hoeller I, Koch R, Stuttmann R: New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. Injury. 2007, 38 (5): 552-558. 10.1016/j.injury.2006.12.023.CrossRefPubMed
48.
Rieger M, Sparr H, Esterhammer R, Fink C, Bale R, Czermak B, Jaschke W: Modern CT diagnosis of acute thoracic and abdominal trauma. Anaesthesist. 2002, 51 (10): 835-842. 10.1007/s00101-002-0369-7.CrossRefPubMed
49.
Wurmb TE, Fruhwald P, Hopfner W, Roewer N, Brederlau J: Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication. Am J Emerg Med. 2007, 25 (9): 1057-1062. 10.1016/j.ajem.2007.03.016.CrossRefPubMed
50.
Wedegartner U, Lorenzen M, Nagel HD, Weber C, Adam G: Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT. RöFo. 2004, 176 (7): 1039-1044.PubMed
Metadata
Title
Comparison of whole-body computed tomography vs selective radiological imaging on outcomes in major trauma patients: a meta-analysis
Authors
Libing Jiang
Yuefeng Ma
Shouyin Jiang
Ligang Ye
Zhongjun Zheng
Yongan Xu
Mao Zhang
Publication date
01-12-2014
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-014-0054-2

Other articles of this Issue 1/2014

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014 Go to the issue

Original research

Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages

Original research

Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis

Original research

Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: lessons learned

Original research

A consensus based template for reporting of pre-hospital major incident medical management

Original research

Mortality in severely injured elderly patients: a retrospective analysis of a German level 1 trauma center (2002–2011)

Study protocol

Study protocol for the PHANTOM study: prehospital assessment of noninvasive tissue oximetry monitoring