Selective computed tomography (CT) versus routine thoracoabdominal CT for high‐energy blunt‐trauma patients
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.
PICOs
Plain language summary
Regular or selected use of computed tomography (CT) scanning to reduce deaths in people who have a high‐energy blunt‐traumatic injury
Background
Trauma is the fifth leading cause of death in the world, and in people younger than 40 years of age, it is the leading cause of death. Since the 2000s, computed tomography (CT) has been increasingly used in the trauma bay. It is more sensitive and specific than conventional radiography and ultrasonography. By the 2010s, with technical and infrastructural improvements, CT has evolved into a reliable and important method of diagnostic imaging in trauma.
Blunt injury may occur following a direct impact (e.g. forced against a steering wheel or floor) or an indirect impact (e.g. acceleration‐deceleration). It is difficult to identify which part of the body is injured following blunt injury and quick and accurate diagnoses are essential to reduce disability and death. The Advanced Trauma Life Support (ATLS®) system is the most commonly used approach and involves a clinical examination and use of diagnostic methods that recognise the most life‐threatening injuries that should be treated first. In the ATLS® approach, conventional diagnostic imaging is performed first (e.g. X‐rays and focused abdominal sonography), followed by selective use of CT of specific body regions if required. In contrast, the use of routine thoracoabdominal (chest and abdomen) CT ensures that therapeutic decisions can be made based on detailed anatomical information of the injuries rather than clinical suspicion. This may lead to quicker and more accurate assessment of injuries present. Consequently, this may lead to improved outcomes.
Study characteristics
We searched medical databases for publications of randomised controlled trials (a clinical study where participants are randomly allocated into treatment groups) comparing the usual approach versus selected use of CT scanning. We included studies of all types of blunt trauma and excluded studies with people with penetrating injuries (e.g. gunshot or knife wounds) and pregnant women. The searches are up‐to‐date to May 2013.
Key results
We found no published or ongoing randomised controlled trials that compared routine versus selective thoracoabdominal CT in blunt‐trauma patients. At this time, it is not possible to say which approach is better for patients, or reduces death.
