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Systematic review and meta-analysis of routine total body CT compared with selective CT in trauma patients

Published on Feb 1, 2014in Emergency Medicine Journal2.31
· DOI :10.1136/emermed-2012-201892
Donagh Healy15
Estimated H-index: 15
(UL: University of Limerick),
Aidan Hegarty1
Estimated H-index: 1
(University Hospital Limerick)
+ 3 AuthorsStewart R. Walsh Mb BCh MRCSEd43
Estimated H-index: 43
(UL: University of Limerick)
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Abstract
Background Full-body CT scanning is increasingly being used in the initial evaluation of severely injured patients. We sought to analyse the literature to determine the benefits of full-body scanning in terms of mortality and length of time spent in the emergency department (ED). Methods A systematic search of the Pubmed and Cochrane Library databases was performed. Eligible studies compared trauma patients managed with selective CT scanning with patients who underwent immediate full-body scanning. Using random effects modelling, the pooled OR was used to calculate the effect of routine full-body CT on mortality while the pooled weighted mean difference was used to analyse the difference in ED time. Results Five studies (8180 patients) provided mortality data while four studies (6073 patients) provided data on ED time. All were non-randomised cohort studies and were prone to several sources of bias. There was no mortality difference between groups (pooled OR=0.68; 95% CI 0.43 to 1.09, p=0.11). There was a significant reduction in the time spent in the ED when patients underwent full-body CT (pooled effect size of weighted mean difference=−32.39 min; 95% CI −51.78 to −13.00; p=0.001). Conclusions We eagerly await the results of randomised controlled trials. Firm clinical outcome data are expected to emerge in the near future, though data on cost and radiation exposure will be needed before definitive conclusions can be made.
  • References (26)
  • Citations (26)
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References26
Newest
Published on Aug 1, 2012in Emergency Medicine Journal2.31
Chris Smith16
Estimated H-index: 16
,
Suzanne Mason30
Estimated H-index: 30
Introduction Whole-body computed tomography (WBCT) is advocated for use in some trauma patients presenting to the emergency department (ED). It is unclear how widespread the use of WBCT is in the UK and the best way to select patients for WBCT remains controversial. The aim of this study was to investigate the current use and nature of WBCT policies in ED in the UK. Methods A postal questionnaire was devised and distributed to lead doctors of 245 ED in the UK in May 2010. Two further rounds of q...
Published on Jun 20, 2012
Stephanie J. Ventura35
Estimated H-index: 35
,
Sally C. Curtin6
Estimated H-index: 6
+ 1 AuthorsStanley Henshaw5
Estimated H-index: 5
Objectives—This report presents detailed pregnancy rates for 1990–2008, updating a national series of rates extending since 1976. Methods—Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. Results—In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1,000 women aged 15–44 is 9 percent b...
Published on Jun 6, 2012
Melonie Heron1
Estimated H-index: 1
OBJECTIVES: This report presents final 2008 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2008. Causes of death classified by t...
Raoul van Vugt4
Estimated H-index: 4
,
Digna R. Kool16
Estimated H-index: 16
+ 1 AuthorsMichael J. Edwards54
Estimated H-index: 54
BACKGROUND: Currently, total body computed tomography (TBCT) is rapidly implemented in the evaluation of trauma patients. With this review, we aim to evaluate the clinical implications-mortality, change in treatment, and time management-of the routine use of TBCT in adult blunt high-energy trauma patients compared with a conservative approach with the use of conventional radiography, ultrasound, and selective computed tomography. METHODS: A literature search for original studies on TBCT in blunt...
Published on Feb 1, 2012in Emergency Medicine Australasia1.50
Ian Cowan1
Estimated H-index: 1
,
Chris Cresswell1
Estimated H-index: 1
+ 3 AuthorsMartin Than28
Estimated H-index: 28
(Christchurch Hospital)
Published on Jan 1, 2012in British Journal of Surgery5.59
Joanne C. Sierink9
Estimated H-index: 9
,
Teun Peter Saltzherr13
Estimated H-index: 13
+ 3 AuthorsJ. C. Goslings16
Estimated H-index: 16
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 select...
Published on Jan 1, 2012in Critical Care6.96
Jean Michel Yeguiayan3
Estimated H-index: 3
(University of Burgundy),
Anabelle Yap1
Estimated H-index: 1
+ 6 AuthorsClaire Bonithon-Kopp38
Estimated H-index: 38
(French Institute of Health and Medical Research)
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 car...
Published on Nov 1, 2011in Annals of Emergency Medicine5.21
Malkeet Gupta8
Estimated H-index: 8
(UCLA: University of California, Los Angeles),
David L. Schriger37
Estimated H-index: 37
(UCLA: University of California, Los Angeles)
+ 4 AuthorsLarry J. Baraff40
Estimated H-index: 40
(UCLA: University of California, Los Angeles)
Study objective Routine pan–computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries. Methods This was a prospective observational study of 701 patients with blunt trauma at an academic trauma center. Be...
Published on Apr 1, 2011in Emergency Medicine Journal2.31
T. Wurmb15
Estimated H-index: 15
,
C Quaisser1
Estimated H-index: 1
+ 5 AuthorsJ Brederlau1
Estimated H-index: 1
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...
Cited By26
Newest
Published on Sep 1, 2019in American Journal of Emergency Medicine1.65
Richard Byrne (Rowan University), Aimee Parks (Rowan University)+ 2 AuthorsBrian W. Roberts1
Estimated H-index: 1
(Rowan University)
Abstract Objective It is unclear if additional computerized tomography (CT) imaging is warranted after injuries are identified on CT in blunt trauma patients. The objective of this study was to determine the incidence and significance of injuries identified on secondary CT imaging after identification of injuries on initial CTs in blunt trauma patients. Methods This was a retrospective cohort study at an academic Level 1 trauma center with a two-tiered trauma system. Inclusion criteria: age ≥ 18...
Published on Aug 1, 2018in Emergency Radiology
Cassandra Jeavons1
Estimated H-index: 1
(Royal Brisbane and Women's Hospital),
Craig Hacking3
Estimated H-index: 3
(Royal Brisbane and Women's Hospital)
+ 1 AuthorsMartin L. Gunn14
Estimated H-index: 14
(UW: University of Washington)
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.
Y. Peñasco3
Estimated H-index: 3
,
María del Juncal Sánchez-Arguiano + 4 AuthorsM. Ortiz-Lasa3
Estimated H-index: 3
Resumen Objetivo 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 toracoabdominopelv...
Y. Peñasco3
Estimated H-index: 3
,
María del Juncal Sánchez-Arguiano + 4 AuthorsM. Ortiz-Lasa3
Estimated H-index: 3
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...
Published on Jun 1, 2018
F. Carpentier1
Estimated H-index: 1
,
J. P. Desclefs + 3 AuthorsG. Valdenaire
Published on Jan 1, 2018
Vittorio Miele16
Estimated H-index: 16
,
Gloria Addeo1
Estimated H-index: 1
+ 4 AuthorsRoberto Grassi29
Estimated H-index: 29
(Seconda Università degli Studi di Napoli)
Trauma is one of the main leading causes of death, and it requires an efficient and well-organized network, including extra and in-hospital care, to significantly reduce the injury-related mortality.
Published on Jan 1, 2018
S. 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...
B. Ali Ali1
Estimated H-index: 1
,
Rolf Lefering1
Estimated H-index: 1
+ 1 AuthorsT. Belzunegui Otano1
Estimated H-index: 1
(University of Navarra)
Background International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain.
Published on Nov 1, 2017in Current Opinion in Critical Care2.54
Stefan Huber-Wagner16
Estimated H-index: 16
,
Karl-Georg Kanz25
Estimated H-index: 25
+ 3 AuthorsRolf Lefering52
Estimated H-index: 52
View next paperSystematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients.