title: Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients: are we getting the whole picture?
abstract: BACKGROUND
  There is considerable interest in whether routine whole-body computed tomography (WBCT) imaging produces different patient outcomes in blunt trauma patients when compared with selective imaging. This article aimed to systematically review the literature for all outcomes measured in comparing WBCT with selective imaging in trauma patients and to evaluate the comprehensiveness of relevant dimensions for this comparison.
  
  
  METHODS
  We performed a systematic review of studies comparing WBCT and selective imaging approaches during the initial assessment of multitrauma patients. Peer-reviewed studies including cohort studies, randomized controlled trials, meta-analyses, and systematic reviews were identified through large database searches and filtered through methodologic inclusion criteria. Data on study characteristics, hypotheses and conclusions made, outcomes assessed, and references to potential benefits and harms were extracted.
  
  
  RESULTS
  Eight retrospective cohort studies and two systematic reviews were identified. Six primary studies evaluated mortality as an outcome, and four studies found a significant difference in results favoring WBCT imaging over selective imaging. All five articles assessing various time intervals in hospital following imaging after injury found significantly reduced times with WBCT. Radiation exposure was found to be increased after WBCT imaging compared with selective imaging in the only study in which it was evaluated. The two systematic reviews analyzed the same three articles with regard to mortality but concluded differently about overall benefits.
  
  
  CONCLUSIONS
  WBCT imaging seems to be associated with reduced times to events in hospital following traumatic injury and seems to be associated with decreased mortality. Whether this is a true effect mediated through an as yet unsubstantiated change in management or the result of hospital- or individual-level confounders is unclear. When evaluating these outcomes, it seems that the authors of both primary studies and systematic reviews have often been selective in their choice of short-term outcomes, painting an incomplete picture of the issue.
  
  
  METHODS
  Systematic review, level III.
authors.affiliation: From the National Trauma Research Institute (A.S., R.L.G.); Emergency Department (A.M.), Department of Radiology (D.K.V.), and Trauma Service (R.L.G.), The Alfred Melbourne; and Department of Surgery (A.S., D.K.V., R.L.G.), Monash University, Melbourne, Australia.
authors.forename: Arthavan
authors.initials: A
authors.lastname: Surendran
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mori
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Varma
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
mesh_terms: D019468:Disease Management; D006801:Humans; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods*