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

Jean-Michel Yeguiayan, Anabelle Yap, Marc Freysz, Delphine Garrigue, Claude Jacquot, Claude Martin, Christine Binquet, Bruno Riou, Claire Bonithon-Kopp, FIRST Study Group, Annie Boillot, Gilles Blasco, Emmanuel Samain, Gilles Capellier, Thibault Desmettre, Gabriel Hamadi, Marc Freysz, Jean-Michel Yeguiayan, Christophe Avena, Sébastien André, Philippe Reviron, Dalila Serradj, Claude Jacquot, Céline Gourle, Julien Brun, Frédéric Mongenot, Elisabeth Rancurel, Bénédicte Bourgeois, Isabelle Favier, François Coppo, Réanimation Neurochirurgicale, Patrick Goldstein, Hervé Coadou, Vincent Marel, Delphine Garrigue, Sandrine Rosenberg, Philippe Poidevin, Bernard Leroy, Dominique Cailloce, Stéphanie Sebban, François Artru, Frédéric Dailler, Thomas Lieutaud, Carole Bodonian, Jacqueline Convert, Pierre Wertheimer, Sarah Lorge, Philippe Rague, Marie Christine Laplace, Carine Delaleu-Rague, Jean-Stéphane David, Laure Besson, Pierre Yves Gueugniaud, François Antonini, Claude Martin, Antoine André, Jean-Pierre Gouraud, Michel Pinaud, Philippe Champin, Dominique Demeure, Pierre Joachim Mahe, Jean Yves Lefrant, Sophie Louvard, Jean Emmanuel De La Coussaye, Pierre Géraud Claret, Aurélie Dardalhon, Jacques Duranteau, Christian Laplace, Gaëlle Cheisson, Bernard Vigué, Pierre-Etienne Leblanc, Olivier Huet, Catherine Ract, Bruno Riou, Danielle Sartorius, Yan Zhao, Olivier Langeron, Frédéric Marmion, Sabine Roche, Julien Amour, Armelle Nicolas Robin, Caroline Télion, Jean-Sébastien Marx, Yaël Ichay, Kim An, Benoit Vivien, Pierre Carli, Jean Yves Lardeur, Etienne Quoirin, Fatima Rayeh, Olivier Mimoz, Claire Bonithon-Kopp, Christine Binquet, Elodie Gautier, Alexandra Félin, Nathalie Berger, Brigitte Lafond, Françoise Casano, Carine Piatek, Alexandra Félin, Jean-Michel Yeguiayan, Anabelle Yap, Marc Freysz, Delphine Garrigue, Claude Jacquot, Claude Martin, Christine Binquet, Bruno Riou, Claire Bonithon-Kopp, FIRST Study Group, Annie Boillot, Gilles Blasco, Emmanuel Samain, Gilles Capellier, Thibault Desmettre, Gabriel Hamadi, Marc Freysz, Jean-Michel Yeguiayan, Christophe Avena, Sébastien André, Philippe Reviron, Dalila Serradj, Claude Jacquot, Céline Gourle, Julien Brun, Frédéric Mongenot, Elisabeth Rancurel, Bénédicte Bourgeois, Isabelle Favier, François Coppo, Réanimation Neurochirurgicale, Patrick Goldstein, Hervé Coadou, Vincent Marel, Delphine Garrigue, Sandrine Rosenberg, Philippe Poidevin, Bernard Leroy, Dominique Cailloce, Stéphanie Sebban, François Artru, Frédéric Dailler, Thomas Lieutaud, Carole Bodonian, Jacqueline Convert, Pierre Wertheimer, Sarah Lorge, Philippe Rague, Marie Christine Laplace, Carine Delaleu-Rague, Jean-Stéphane David, Laure Besson, Pierre Yves Gueugniaud, François Antonini, Claude Martin, Antoine André, Jean-Pierre Gouraud, Michel Pinaud, Philippe Champin, Dominique Demeure, Pierre Joachim Mahe, Jean Yves Lefrant, Sophie Louvard, Jean Emmanuel De La Coussaye, Pierre Géraud Claret, Aurélie Dardalhon, Jacques Duranteau, Christian Laplace, Gaëlle Cheisson, Bernard Vigué, Pierre-Etienne Leblanc, Olivier Huet, Catherine Ract, Bruno Riou, Danielle Sartorius, Yan Zhao, Olivier Langeron, Frédéric Marmion, Sabine Roche, Julien Amour, Armelle Nicolas Robin, Caroline Télion, Jean-Sébastien Marx, Yaël Ichay, Kim An, Benoit Vivien, Pierre Carli, Jean Yves Lardeur, Etienne Quoirin, Fatima Rayeh, Olivier Mimoz, Claire Bonithon-Kopp, Christine Binquet, Elodie Gautier, Alexandra Félin, Nathalie Berger, Brigitte Lafond, Françoise Casano, Carine Piatek, Alexandra Félin

Abstract

Introduction: The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.

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 72 hours. 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 1,950 patients. The main endpoint was 30-day mortality.

Results: In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 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.

Conclusions: Diagnostic whole-body 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.

Figures

Figure 1
Figure 1
Study flow chart. CT, computed tomography; FIRST, French Intensive care Recorded in Severe Trauma.
Figure 2
Figure 2
Odds ratio for 30-day mortality associated with whole-body computed tomography (CT) by several adjustment methods. C index statistic corresponding to the area under the receiver operating characteristic (ROC) curve *Multivariate logistic regression adjusted for pre-CT (age, hemoglobin, prothrombin ratio, ventilation, Glasgow Coma Scale, fluid loading, center, and pre-hospital cardiac arrest) and post-CT confounders (number of packed red blood cells in the first 24 hours and catecholamine administration in the first 24 hours). †Multivariate logistic regression adjusted for post-CT confounders (number of packed red blood cells in the first 24 hours and catecholamine administration in the first 24 hours). CI, confidence interval; OR, odds ratio.

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