title: Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Traumatic injury in the United States is the Number 1 cause of mortality for patients 1 year to 44 years of age. Studies suggest that early identification of major injury leads to better outcomes for patients. Imaging, such as computed tomography (CT), is routinely used to help determine the presence of major underlying injuries. We review the literature to determine whether whole-body CT (WBCT), a protocol including a noncontrast scan of the brain and neck and a contrast-enhanced scan of the chest, abdomen, and pelvis, detects more clinically significant injuries as opposed to selective scanning as determined by mortality rates.
  
  
  METHODS
  Scientific publications from 1980 to 2013 involving the study of the difference between pan scan and selective scan after trauma were identified. The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used. Publications were categorized by level of evidence. Injury Severity Score (ISS) and pooled odds for mortality rate of patients who received WBCT scan versus those who received selective scans were compared.
  
  
  RESULTS
  Of the 465 publications identified, 7 were included, composing of 25,782 trauma patients who received CT scan following trauma. Of the patients, 52% (n = 13,477) received pan scan and 48% (n = 12,305) received selective scanning. Overall ISS was significantly higher for patients receiving WBCT versus those receiving selective scan (29.7 vs. 26.4, p < 0.001, respectively). Overall mortality rate was significantly lower for WBCT versus selective scanning (16.9; 95% confidence interval [CI], 16.3-17.6 vs. 20.3; 95% CI, 19.6-21.1, p < 0.0002, respectively). Pooled odds ratio for mortality rate was 0.75 (95% CI, 0.7-0.79), favoring WBCT.
  
  
  CONCLUSIONS
  Despite the WBCT group having significantly higher ISS at baseline compared with the group who received selective scanning, the WBCT group had a lower overall mortality rate and a more favorable pooled odds ratio for trauma patients. This suggests that in terms of overall mortality, WBCT scan is preferable to selective scanning in trauma patients.
  
  
  METHODS
  Systematic review and meta-analysis, level III.
authors.affiliation: From the Department of Emergency Medicine (N.D.C., C.S.), Lincoln Medical and Mental Health Center, Bronx; and Department of Emergency Medicine (G.L., K.S.), Icahn School of Medicine, Mount Sinai Hospital, New York, New York.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Caputo
authors.forename: Chris
authors.initials: C
authors.lastname: Stahmer
authors.forename: George
authors.initials: G
authors.lastname: Lim
authors.forename: Kaushal
authors.initials: K
authors.lastname: Shah
mesh_terms: D006801:Humans; D015601:Injury Severity Score; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality*