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Whole-Body Computed Tomography During Initial Management and Mortality Among Adult Severe Blunt Trauma Patients: A Nationwide Cohort Study

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Abstract

Background

Whole-body computed tomography (WBCT) is increasingly being incorporated into the initial management of blunt trauma patients. Several observational studies have suggested that, compared to selective CT, WBCT is associated with lower mortality. In contrast, a randomized controlled trial found no significant difference in survival between patients undergoing WBCT compared to selective CT. Our objective was to confirm the association between WBCT and in-hospital mortality among adult severe blunt trauma patients.

Methods

This was a retrospective cohort study based on Japan Trauma Data Bank 2004–2015 registry data. The study population comprised adult severe blunt trauma patients with at least one abnormal vital sign: systolic blood pressure ≤100 mmHg, heart rate ≥120, respiratory rate ≥30 or ≤10, or Glasgow Coma Score ≤13. The primary outcome was in-hospital mortality. To adjust for both measured and unmeasured confounders, we performed instrumental variable (IV) analysis to compare the in-hospital mortality of patients undergoing WBCT with those undergoing selective CT.

Results

Of 40,435 patients who were eligible for this study, 19,766 (48.9%) patients underwent WBCT. The proportion of patients undergoing WBCT significantly increased during the study period, from 10.7% in 2004 to 59.6% in 2015. Primary IV analysis showed a significant association between WBCT and lower in-hospital mortality (odds ratio 0.84, 95% confidence interval 0.72–0.98).

Conclusions

WBCT can be beneficial in patients with blunt trauma which has compromised vital signs. These findings from a nationwide study suggest that physicians should consider WBCT for blunt trauma patients when warranted by vital signs.

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Acknowledgements

We would like to thank all members and personnel of the JTDB, the Japanese Association for Trauma Surgery, the Japanese Association for Acute Medicine, and Japan Trauma Care and Research. We thank Libby Cone, MD, MA, and Guy Harris, DO from DMC Corp. (www.dmed.co.jp) for editing drafts and the revised version of this manuscript.

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Authors and Affiliations

  1. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Yusuke Tsutsumi, Yosuke Yamamoto & Shunichi Fukuhara

  2. Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Yoshida-Kawahara-machi, Sakyo-ku, Kyoto, 606-8507, Japan

    Shingo Fukuma

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Asuka Tsuchiya

  4. Department of Emergency Medicine, National Hospital Organization Mito Medical Center, 280 Sakuranosato Ibaraki-machi, Higashiibaraki-gun, Ibaraki, 311-3117, Japan

    Yusuke Tsutsumi & Asuka Tsuchiya

Authors
  1. Yusuke Tsutsumi
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  2. Shingo Fukuma
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Correspondence to Shingo Fukuma.

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268_2018_4732_MOESM3_ESM.pdf

Absolute standardized differences in measured confounders between IV and actual treatment. IV, instrumental variable; ISS, injury severity score (PDF 84 kb)

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Tsutsumi, Y., Fukuma, S., Tsuchiya, A. et al. Whole-Body Computed Tomography During Initial Management and Mortality Among Adult Severe Blunt Trauma Patients: A Nationwide Cohort Study. World J Surg 42, 3939–3946 (2018). https://doi.org/10.1007/s00268-018-4732-5

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  • DOI: https://doi.org/10.1007/s00268-018-4732-5

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