TDNet Discover

Background: Current guidelines surrounding evaluation of trauma patients in the emergency department suggest performing a physical exam (PE), conventional diagnostic imaging, e.g., radiography and focused abdominal sonography in trauma (FAST) exam, and then concluding with selective computer tomography (CT) scans if deemed necessary. There is current literature that investigates the use of total body computed tomography (TBCT) for initial evaluation of blunt, life-threatening injuries, but there is limited level 1 evidence firmly supporting or refuting this approach. Purpose: The goal of our research is to further compare mortality outcomes, changes in treatment plans post-imaging, impact of radiation exposure, and time effectiveness between blunt trauma patients who receive specific body region CT scans as opposed to TBCT scans. Methods: A literature search was performed by three separate researchers to obtain multiple studies of various designs that questioned whether mortality, changes in treatment, radiation exposure, and/or time management was affected when diagnosing patients with immediate TBCT scanning. One article was chosen by each researcher and data was extracted. The researchers discussed the quality of each article before synthesizing the data points into this evidenced-based clinical review. Results: A total of 6,712 patients were included in the mortality analysis, and a significant increase in mortality with TBCT was only found after a risk-adjusted approach was made. Thoracic injuries were significantly more likely to be picked up on TBCT resulting in change of treatment plan (p <0.001), but in cases of injuries in other body regions, there were similar findings amongst the two groups. Median radiation exposure in the trauma room was higher in patients in the TBCT group than in those in the standard work-up group (p<0.0001) and was also v higher in the TBCT group during total hospital admission (p<0.0001). The REACT-2 trial concluded that the radiation dose was increased in patients in the TBCT group, and substantially more patients in the standard work-up group received a lower radiation dose. Time elapsed between trauma room arrival and end of imaging was significantly shorter with TBCT (p < 0.0001), as was with time from arrival to diagnosis (p < 0.0001). Conclusion: Based on the results of this evidence-based clinical review, TBCT does not reduce mortality rates, but further research should be conducted to evaluate its role in improving length and course of treatment without harming patients from a radiation standpoint.