title: A case-matched series of immediate total-body CT scanning versus the standard radiological work-up in trauma patients.
abstract: BACKGROUND
  In recent years computed tomography (CT) has become faster and more available in the acute trauma care setting. The aim of the present study was to compare injured patients who underwent immediate total-body CT (TBCT) scanning with patients who underwent the standard radiological work-up with respect to 30-day mortality.
  
  
  METHODS
  Between January 2009 and April 2011, 152 consecutive patients underwent immediate TBCT scanning as part of a prospective pilot study. These patients were case-matched by age, gender, and Injury Severity Score (ISS) category with control patients from a historical cohort (July 2006-November 2007) who had undergone X-rays and focused assessment with sonography for trauma, followed by selective CT scanning.
  
  
  RESULTS
  Despite comparable demographics, TBCT patients had a lower median Glasgow Coma Score (GCS) than controls (10 vs. 15; p < 0.001) and on-scene endotracheal intubation was performed more often (33 vs. 19 %; p = 0.004). 30-day mortality was 13 % in the TBCT patient group versus 13 % in the control group (p = 1.000). A generalized linear mixed model analysis showed that a higher in-hospital GCS [odds ratio (OR) 0.8, 95 % confidence interval (CI) 0.745-0.86; p < 0.001] and immediate TBCT scanning (OR 0.46, 95 % CI 0.236-0.895; p = 0.022) were associated with decreased 30-day mortality, while a higher ISS (OR 1.054, 95 % CI 1.028-1.08) p < 0.001) was associated with increased 30-day mortality.
  
  
  CONCLUSIONS
  Trauma patients who underwent immediate TBCT scanning had similar absolute 30-day mortality rates compared to patients who underwent conventional imaging and selective CT scanning. However, immediate TBCT scanning was associated with a decreased 30-day mortality after correction for the impact of differences in raw ISS and in-hospital GCS.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, j.c.sierink@amc.nl.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Sierink
authors.forename: Teun Peter
authors.initials: TP
authors.lastname: Saltzherr
authors.forename: Ludo F M
authors.initials: LF
authors.lastname: Beenen
authors.forename: Marjolein J A M
authors.initials: MJ
authors.lastname: Russchen
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality