Whole Body CT vs. Selective Scanning in Trauma
Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: A systematic review and meta-analysis. Caputo ND, Stahmer C, et al. J Trauma Acute Care Surg, (2014)77:534-539
Following a traumatic injury, will whole body CT (WBCT) scanning as opposed to selectively scanning detect more clinically significant injuries as determined by mortality rates?
465 publications were reviewed and 7 included in the analysis, totaling 25,782 trauma patients. Patients who received a WBCT scan (head, neck, chest, abdomen, and pelvis) were compared to those who were scanned selectively based on injuries following significant trauma as determined by the Injury Severity Score (ISS). Odd ratios of mortality were calculated.
Overall ISS was significantly higher in the WBCT cohort while overall mortality was significantly lower for WBCT vs selective scanning (16.9; 95% CI 16.3-17.6 vs 20.3; 19.6-21.1, p<0.0002). Pooled odds ratio for mortality was 0.75; 95% CI 0.7-0.79 in favor of WBCT.
While the WBCT patients had a higher ISS, they had a lower overall mortality and more favorable odds of mortality then selective scanning. Limitations are retrospective data, although the prospective, randomized REACT-2 trial is currently under way.