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. 2013 Dec 23;2013(12):CD009743.
doi: 10.1002/14651858.CD009743.pub2.

Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients

Raoul Van Vugt  1 , Frederik Keus, Digna Kool, Jaap Deunk, Michael Edwards
Affiliations

Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients

Raoul Van Vugt et al. Cochrane Database Syst Rev. .

Abstract

Background: Trauma is the fifth leading cause of death worldwide, and in people younger than 40 years of age, it is the leading cause of death. During the resuscitation of trauma patients at the emergency department, there are two different commonly used diagnostic strategies. Conventionally, there is the use of physical examination and conventional diagnostic imaging, potentially followed by selective use of computed tomography (CT). Alternatively, there is the use of physical examination and conventional diagnostics, followed by a routine (instead of selective) use of thoracoabdominal CT. It is currently unknown which of the two strategies is the better diagnostic strategy for patients with blunt high-energy trauma.

Objectives: To assess the effects of routine thoracoabdominal CT compared with selective thoracoabdominal CT on mortality in blunt high-energy trauma patients.

Search methods: We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (Issue 4, 2013); MEDLINE (OvidSP), EMBASE (OvidSP) and CINAHL for all published randomised controlled trials (RCTs). We did not restrict the searches by language, date or publication status. We conducted the search on the 9 May 2013.

Selection criteria: We included RCTs of trauma resuscitation algorithms using routine thoracoabdominal CT versus algorithms using selective CT in this review. We included all blunt high-energy trauma patients (including blast or barotrauma).

Data collection and analysis: Two authors independently evaluated the search results.

Main results: The systematic search identified 481 references; after removal of duplicates, 396 remained. We found no RCTs comparing routine versus selective thoracoabdominal CT in blunt high-energy trauma patients. We excluded 381 studies based on the abstracts of the publications because of irrelevance to the review topic, and a further 15 studies after full-text evaluation.

Authors' conclusions: We found no RCTs of routine versus selective thoracoabdominal CT in patients with blunt high-energy trauma. Based on the lack of evidence from RCTs, it is not possible to say which approach is better in reducing deaths.

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Conflict of interest statement

None known.

Figures

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Study flow diagram.
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  • doi: 10.1002/14651858.CD009743

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References

References to studies excluded from this review

Deunk 2009 {published data only}
    1. Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, Vugt AB, et al. Routine versus selective multidetector‐row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management. Journal of Trauma 2009;67(5):1080‐6. - PubMed
Huber‐Wagner 2009 {published data only}
    1. Huber‐Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, et al. Effect of whole‐body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 2009;373(9673):1455‐61. - PubMed
Hutter 2011 {published data only}
    1. Hutter M, Woltmann A, Hierholzer C, Gärtner C, Bühren V, Stengel D. Association between a single‐pass whole‐body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011;19:73. - PMC - PubMed
Okamoto 2002 {published data only}
    1. Okamoto K, Norio H, Kaneko N, Sakamoto T, Kaji T, Okada Y. Use of early‐phase dynamic spiral computed tomography for the primary screening of multiple trauma. American Journal of Emergency Medicine 2002;20(6):528‐34. - PubMed
Rieger 2009 {published data only}
    1. Rieger M, Czermak B, Attal R, Sumann G, Jaschke W, Freund M. Initial clinical experience with a 64‐MDCT whole‐body scanner in an emergency department: better time management and diagnostic quality?. Journal of Trauma 2009;66(3):648‐57. - PubMed
Salim 2006 {published data only}
    1. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Archives of Surgery 2006;141(5):468‐75. - PubMed
Sampson 2006 {published data only}
    1. Sampson MA, Colquhoun KB, Hennessy NL. Computed tomography whole body imaging in multi‐trauma: 7 years experience. Clinical Radiology 2006;61(4):365‐9. - PubMed
Self 2013 {published data only}
    1. Self ML, Blake AM, Whitley M, Nadalo L, Dunn E. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. American Journal of Surgery 2003;186(6):609‐14. - PubMed
Smith 2011 {published data only}
    1. Smith CM, Woolrich‐Burt L, Wellings R, Costa ML. Major trauma CT scanning: the experience of a regional trauma centre in the UK. Emergency Medicine Journal 2011;28(5):378‐82. - PubMed
Stengel 2009 {published data only}
    1. Stengel D, Frank M, Matthes G, Schmucker U, Seifert J, Mutze S, et al. Primary pan‐computed tomography for blunt multiple trauma: can the whole be better than its parts?. Injury 2009;40 (Suppl 4):S36‐46. - PubMed
Tillou 2009 {published data only}
    1. Tillou A, Gupta M, Baraff LJ, Schriger DL, Hoffman JR, Hiatt JR, et al. Is the use of pan‐computed tomography for blunt trauma justified? A prospective evaluation. Journal of Trauma 2009;67(4):779‐87. - PubMed
Weninger 2007 {published data only}
    1. Weninger P, Mauritz W, Fridrich P, Spitaler R, Figl M, Kern B, et al. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. Journal of Trauma 2007;62(3):584‐91. - PubMed
Wurmb 2009 {published data only}
    1. Wurmb TE, Frühwald P, Hopfner W, Keil T, Kredel M, Brederlau J, et al. Whole‐body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. Journal of Trauma 2009;66(3):658‐65. - PubMed
Wurmb 2011 {published data only}
    1. Wurmb TE, Quaisser C, Balling H, Kredel M, Muellenbach R, Kenn W, et al. Whole‐body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma. Emergency Medicine Journal 2011;28(4):300‐4. - PubMed
Yeguiayan 2012 {published data only}
    1. Yeguiayan JM, Yap A, Freysz M, Garrigue D, Jacquot C, Martin C, et al. Impact of whole‐body computed tomography on mortality and surgical management of severe blunt trauma. Critical Care 2012;16(3):R101. - PMC - PubMed

References to ongoing studies

REACT‐2 {published data only}
    1. Sierink JC, Saltzherr TP, Beenen LF, Luitse JS, Hollmann MW, Reitsma JB, et al. A multicenter, randomized controlled trial of immediate total‐body CT scanning in trauma patients (REACT‐2). BMC Emergency Medicine 2012;12:4. - PMC - PubMed

Additional references

ATLS 2012
    1. Committee on Trauma: American College of Surgeons. Advanced Trauma Life Support (ATLS®). 9th Edition. Chicago: American College of Surgeons, 2012.
Brink 2008
    1. Brink M, Deunk J, Dekker HM, Kool DR, Edwards MJ, Vugt AB, et al. Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management. American Journal of Roentgenology 2008;190(6):1591‐8. - PubMed
Davis 1992
    1. Davis JW, Hoyt DB, McArdle MS, Mackersie RC, Eastman AB, Virgilio RW, et al. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. Journal of Trauma 1992;32(5):660‐5. - PubMed
Deeks 2003
    1. Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non‐randomised intervention studies. Health Technology Assessment 2003;7(27):iii‐x,1‐173. - PubMed
Deunk 2007
    1. Deunk J, Dekker HM, Brink M, Vugt R, Edwards MJ, Vugt AB. The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work‐up for blunt trauma patients. Journal of Trauma 2007;63(4):757‐63. - PubMed
Devine 2010
    1. Devine AS, Jackson CS, Lyons L, Mason JD. Frequency of incidental findings on computed tomography of trauma patients. Western Journal of Emergency Medicine 2010;11:24‐7. - PMC - PubMed
Donner 1980
    1. Donner A, Koval JJ. The estimation of intraclass correlation in the analysis of family data. Biometrics 1980;36(1):19‐25. - PubMed
Fakhry 2000
    1. Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. Journal of Trauma 2000;48(3):408‐14. - PubMed
Higgins 2002
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Higgins 2011
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from www.cochrane‐handbook.org.
Hozo 2005
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5(1):13. - PMC - PubMed
Inaba 2011
    1. Inaba K, Branco BC, Lim G, Russell K, Teixeira PG, Lee K, et al. The increasing burden of radiation exposure in the management of trauma patients. Journal of Trauma 2011;70(6):1366‐70. - PubMed
Ioannidis 2001
    1. Ioannidis JP, Haidich AB, Pappa M, Pantazis N, Kokori SI, Tektonidou MG, et al. Comparison of evidence of treatment effects in randomized and nonrandomized studies. JAMA 2001;286(7):821‐30. - PubMed
Jakobsen 2013
    1. Jakobsen JC, Gluud C. The necessity of randomized clinical trials. British Journal of Medicine and Medical Research 2013;3(4):1453‐68.
Keus 2010
    1. Keus F, Wetterslev J, Gluud C, Laarhoven CJ. Evidence at a glance: error matrix approach for overviewing available evidence. BMC Medical Research Methodology 2010;10:90. - PMC - PubMed
Kool 2007
    1. Kool DR, Blickman JG. Advanced Trauma Life Support. ABCDE from a radiological point of view. Emergency Radiology 2007;14(3):135‐41. - PMC - PubMed
Macaskill 2001
    1. Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta‐analysis. Statistics in Medicine 2001;20(4):641‐54. - PubMed
Maurer 2008
    1. Maurer MH, Knopke S, Schröder RJ. Added diagnostic benefit of 16‐row whole‐body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS concept. Rofo 2008;180:1117‐23. - PubMed
Pal 2002
    1. Pal JD, Victorino GP. Defining the role of computed tomography in blunt abdominal trauma: use in the hemodynamically stable patient with a depressed level of consciousness. Archives of Surgery 2002;137(9):1029‐33. - PubMed
Papanikolaou 2006
    1. Papanikolaou PN, Christidi GD, Ioannidis JP. Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies. Canadian Medical Association Journal 2006;174(5):635‐41. - PMC - PubMed
Rao 1992
    1. Rao JNK, Scott AJ. A simple method for the analysis of clustered binary data. Biometrics 1992;48(2):577‐85. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) 5. Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Rhee 2002
    1. Rhee PM, Bridgeman A, Acosta JA, Kennedy S, Wang DS, Sarveswaran J, et al. Lumbar fractures in adult blunt trauma: axial and single‐slice helical abdominal and pelvic computed tomographic scans versus portable plain films. Journal of Trauma 2002;53(4):663‐7. - PubMed
Trupka 1997
    1. Trupka A, Kierse R, Waydhas C, Nast‐Kolb D, Blahs U, Schweiberer L, et al. Shock room diagnosis in polytrauma. Value of thoracic CT [Schockraumdiagnostik beim Polytrauma. Wertigkeit der Thorax CT]. Der Unfallchirurg 1997;100(6):469‐76. - PubMed
Whiting‐O'Keefe 1984
    1. Whiting‐O'Keefe QE, Henke C, Simborg DW. Choosing the correct unit of analysis in medical care experiments. Medical Care 1984;22(12):1101‐14. - PubMed
WHO 2008
    1. World Health Organization (WHO). World Health Statistics 2008. www.who.int/whosis/whostat/2008/en/index.html (accessed 2 December 2012).
WHO 2012
    1. World Health Organization (WHO) Databank. WHO statistical information system. www.who.int/whosis (accessed 2 December 2013).
WHO Eur 2008
    1. World Health Organization, Regional Office for Europe. Atlas of health, 2nd edition 2008. www.euro.who.int/__data/assets/pdf_file/0011/97598/E91713.pdf (accessed 2 December 2013).

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