title: The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma: A retrospective cohort study.
abstract: We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT.Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome.Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients' time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06-0.75, P = 0.016).Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.
authors.affiliation: General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center Graduate Institute of Medical Sciences, National Defense Medical Center School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Hong
authors.forename: Cheng-Jueng
authors.initials: CJ
authors.lastname: Chen
authors.forename: Jyh-Cherng
authors.initials: JC
authors.lastname: Yu
authors.forename: De-Chuan
authors.initials: DC
authors.lastname: Chan
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Liang
authors.forename: Sheng-Der
authors.initials: SD
authors.lastname: Hsu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000639:trends*; D014474:Unconsciousness; D051598:Whole Body Imaging; D055815:Young Adult