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Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients.

Published on Jan 1, 2012in British Journal of Surgery5.586
· DOI :10.1002/bjs.7760
J.C. Sierink9
Estimated H-index: 9
,
T. P. Saltzherr15
Estimated H-index: 15
+ 3 AuthorsJ. C. Goslings2
Estimated H-index: 2
Abstract
Background: The aim of this review was to assess the value of immediate total-body computed tomography (CT) during the primary survey of injured patients compared with conventional radiographic imaging supplemented with selective CT. Methods: A systematic search of the literature was performed in MEDLINE, Embase, Web of Science and Cochrane Library databases. Reports were eligible if they contained original data comparing immediate total-body CT with conventional imaging supplemented with selective CT in injured patients. The main outcomes of interest were overall mortality and time in the emergency room (ER). Results: Four studies were included describing a total of 5470 patients; one study provided 4621 patients (84.5 per cent). All four studies were non-randomized cohort studies with retrospective data collection. Mortality was reported in three studies. Absolute mortality rates differed substantially between studies, but within studies mortality rates were comparable between immediate total-body CT and conventional imaging strategies (pooled odds ratio 0.91, 95 per cent confidence interval 0.79 to 1.05). Time in the ER was described in three studies, and in two was significantly shorter in patients who underwent immediate total-body CT: 70 versus 104 min (P = 0.025) and 47 versus 82 min (P <0.001) respectively. Conclusion: This review showed differences in time in the ER in favour of immediate total-body CT during the primary trauma survey compared with conventional radiographic imaging supplemented with selective CT. There were no differences in mortality. The substantial reduction in time in the ER is a promising feature of immediate total-body CT but well designed and larger randomized studies are needed to see how this will translate into clinical outcomes
  • References (33)
  • Citations (59)
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References33
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#1GA Wells (U of O: University of Ottawa)H-Index: 1
#2B SheaH-Index: 1
Last. George A. Wells (U of O: University of Ottawa)H-Index: 126
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Nonrandomised studies, including case-control and cohort studies, can be challenging to implement and conduct. Assessment of the quality of such studies is essential for a proper understanding of nonrandomised studies. The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the qual...
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Background:Multislice whole body computed tomography is regarded as the method of choice for primary investigation of hemodynamically stable patients with multiple injuries. However, a disadvantage of this method is the high level of radiation to which the patient is exposed. Various recommendations
21 CitationsSource
#1Thomas WurmbH-Index: 15
#2C QuaisserH-Index: 1
Last. Jörg BrederlauH-Index: 18
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Objectives Whole-body multislice helical CT becomes increasingly important as a diagnostic tool in patients with multiple injuries. Time gain in multiple-trauma patients who require emergency surgery might improve outcome. The authors hypothesised that whole-body multislice computed tomography (MSCT) (MSCT trauma protocol) as the initial diagnostic tool reduces the interval to start emergency surgery (tOR) if compared to conventional radiography, combined with abdominal ultrasound and organ-focu...
71 CitationsSource
#1David Moher (Ottawa Hospital Research Institute)H-Index: 100
#2Alessandro Liberati (University of Birmingham)H-Index: 45
Last. Douglas G. Altman (University of Oxford)H-Index: 209
view all 4 authors...
30.8k CitationsSource
#1David MoherH-Index: 100
#2Alessandro LiberatiH-Index: 45
Last. Douglas G. AltmanH-Index: 209
view all 4 authors...
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field,1,2 and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research,3 and some health care journals are moving in this direction.4 As with all research, the value of a systematic review depends on what was done, what was found...
31.5k Citations
#1Stefan Huber-Wagner (LMU: Ludwig Maximilian University of Munich)H-Index: 17
#2Rolf LeferingH-Index: 53
Last. K.-G. Kanz (LMU: Ludwig Maximilian University of Munich)H-Index: 10
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8 CitationsSource
#1Stefan Huber-Wagner (LMU: Ludwig Maximilian University of Munich)H-Index: 17
#2Rolf LeferingH-Index: 53
Last. Karl-Georg Kanz (LMU: Ludwig Maximilian University of Munich)H-Index: 25
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135 CitationsSource
PURPOSE: Whole-body CT scans for patients with multiple trauma represent an increasingly accepted first diagnostic tool. The multidetector approach in particular provides appropriate diagnostic algorithms for detecting nearly all relevant traumatic findings in a short time with a high grade of sensitivity and specificity. Non-trauma-associated additional findings are commonly depicted based on these CT examinations. The aim of this study is to evaluate the number and quality of these additional ...
21 CitationsSource
Summary Background Time-critical care of seriously injured patients is gaining more and more significance. The availability of the multi-slice CT allows a complete diagnostic assessment of injured patients in 90–240 s, but is presently carried out only at the conclusion of basic diagnostics. We investigated the effects of a clinical algorithm using multi-slice CT scanning ahead of other measures in the clinical care of seriously injured patients. Methods Availability of a trauma admitting room w...
93 CitationsSource
Cited By59
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#1Philip Beak (St George’s University Hospitals NHS Foundation Trust)
#2Ben Gabbott (St George’s University Hospitals NHS Foundation Trust)
Last. Caroline B. Hing (St George’s University Hospitals NHS Foundation Trust)H-Index: 1
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Introduction Management of major trauma patients with evidence of polytrauma involves the use of immediate whole-body CT (WBCT). Identification of patients appropriate for immediate WBCT remains challenging. Our study aimed to assess for improvement in patient selection for WBCT over time as a major trauma centre (MTC).
Source
#1Siobhán B. O’Neill (UBC: University of British Columbia)H-Index: 1
#2Brian Gibney (UBC: University of British Columbia)
Last. Luck J. Louis (UBC: University of British Columbia)H-Index: 10
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A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from pass...
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Abstract Objective To determine the relationship between the use of whole-body computed tomography (WB-CT) and hospital mortality in elderly patients with thoracic–abdominal–pelvic injury requiring admission to an intensive care unit. Patients and method An observational, descriptive and retrospective study was conducted on 140 patients aged 65 years and older admitted to the intensive care unit after a thoracic–abdominal–pelvic injury. Two groups were established, depending on whether a WB-CT w...
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espanolObjetivo Analizar la asociacion de la realizacion de una tomografia computarizada (TC) corporal con la mortalidad intrahospitalaria en pacientes de edad avanzada con afectacion toracoabdominopelvica que precisa ingreso en una unidad de cuidados intensivos. Pacientes y metodo Estudio observacional, descriptivo y retrospectivo realizado sobre 140 pacientes con edad igual o mayor de 65 anos ingresados en una unidad de cuidados intensivos tras un traumatismo con afectacion toracoabdominopelvi...
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#1Cassandra Jeavons (Royal Brisbane and Women's Hospital)H-Index: 1
#2Craig Hacking (Royal Brisbane and Women's Hospital)H-Index: 4
Last. Martin L. Gunn (UW: University of Washington)H-Index: 14
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Purpose The purpose of this study was to review and compare the image quality and radiation dose of split-bolus single-pass computed tomography(CT) in the assessment of trauma patients in comparison to standard multi-phase CT techniques.
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#1Enver Özçete (Ege University)H-Index: 2
#2Selahattin Kiyan (Ege University)H-Index: 9
Last. Yusuf Ali Altunci (Ege University)H-Index: 3
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Backround:High rates in trauma-related mortality pose a major health problem and increase every day. Early diagnosis and treatment can be lifesavers for this patient group in the emergency departments, which serve as the first place to admit trauma patients in a hospital.Objectives:We aim to determine high-risk criteria to indicate trauma patients getting the most use from whole-body tomography in patients with multiple traumas and reduce unnecessary computed tomography.Methods:We examined retro...
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#1M. T. SwarbrickH-Index: 1
#2S. E. PowellH-Index: 2
Last. E. HaggettH-Index: 1
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Summary Head trauma is a common injury in young horses. This case report describes a 10-week-old Thoroughbred foal with an open wound following trauma to the poll region, showing abnormal head carriage and depression. A computed tomography (CT) study was performed under general anaesthetic (GA). This identified a complete avulsion of the nuchal ligament (NL) and partial avulsions of the left and right semispinalis capitis (SS) tendons. Following diagnosis and conservative treatment the foal made...
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Last. H. Polak
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#1Laura B. Eisenmenger (UofU: University of Utah)H-Index: 6
#2Booth Aldred (UofU: University of Utah)H-Index: 3
Last. Marta E. Heilbrun (Emory University)H-Index: 20
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Traumatic injuries are the leading cause of death of individuals between the ages of 1 and 44 in the USA with both blunt thorax and abdominal trauma causing significant morbidity and mortality. Appropriate utilization of imaging is essential to the management of trauma. Understanding both the initial and secondary imaging modalities of choice based on the trauma severity, location of injury, and clinical condition is important. Initial imaging must allow for rapid identification of life-threaten...
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#1S. Huber-Wagner (TUM: Technische Universität München)
Die rasche und sichere radiologische Diagnostik stellt einen relevanten Schlusselbereich in der Versorgung polytraumatisierter Patienten dar. Mittlerweile gibt es zahlreiche Daten zum Nutzen der Ganzkorpercomputertomographie (GKCT) als Standarddiagnostik im Rahmen der Schwerstverletztenversorgung. Zusatzlich konnte durch moderne iterative Protokolle eine Reduktion der Strahlenbelastung der GKCT um 30–80 % realisiert werden. Die Durchfuhrung einer GKCT bei Schwerverletzten wahrend der Schockraump...
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