Systematic review: effect of whole-body computed tomography on mortality in trauma patients

Shahab Hajibandeh, Shahin Hajibandeh, Shahab Hajibandeh, Shahin Hajibandeh

Abstract

Background: The initial diagnostic evaluation and management of trauma patients is mainly based on Advanced Trauma Life Support (ATLS) guidelines worldwide. Based on ATLS principles, conventional diagnostics such as conventional radiography (CR) and focused abdominal sonography in trauma (FAST) should precede selective use of CT. Whole-body CT (WBCT) is highly accurate and allows detection of life threatening injuries with good sensitivity and specificity. WBCT is faster than conventional diagnostics and saves more time in management of trauma patients. This study aims to review studies investigating the effect of WBCT on mortality in trauma patients.

Methods: Literatures were found by searching keywords in Medline, PubMed and Cochrane library. The relevant articles were selected by two independent reviewers based on title, abstract and introduction sections. Full-texts of selected articles were reviewed and those investigating effect of WBCT on mortality in trauma patients were included.

Results: Searching the keywords in Medline and PubMed resulted in 178 and 167 articles, respectively. Nine studies met the inclusion criteria and were reviewed. These included 8 retrospective and 1 prospective cohort studies. Mortality was measured as mortality rate or standardised mortality ratio (SMR) in the included studies.

Conclusions: Unlike previous systematic reviews, this review indicates that use of WBCT in blunt trauma patients is associated with reduced overall mortality rate and that WBCT can potentially improve the probability of survival in haemodynamically stable and unstable blunt trauma patients. High quality RCTs are required to describe a causal relationship between WBCT and mortality in trauma patients.

Trial registration: ClinicalTrials.gov NCT01523626.

© 2015 KUMS, All rights reserved.

Figures

Figure 1. Flow chart for the review
Figure 1. Flow chart for the review
Figure 2. Forest plot of odds ratio…
Figure 2. Forest plot of odds ratio for mortality (Random effect).
Figure 3. Forest plot of TRISS –Based…
Figure 3. Forest plot of TRISS –Based SMR in WBCT group (Random effect).
Figure 4. Forest plot of TRISS –Based…
Figure 4. Forest plot of TRISS –Based SMR in non-WBCT group (Random effect).
Figure 5. Forest plot of RISC –Based…
Figure 5. Forest plot of RISC –Based SMR in WBCT group (Random effect).
Figure 6. Forest plot of RISC –Based…
Figure 6. Forest plot of RISC –Based SMR in non-WBCT group (Random effect).

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Source: PubMed

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