title: Whole body CT versus selective radiological imaging strategy in trauma: an evidence-based clinical review.
abstract: BACKGROUND
  Trauma patients often present with injuries requiring resuscitation and further evaluation. Many providers advocate for whole body computed tomography (WBCT) for rapid and comprehensive diagnosis of life-threatening injuries.
  
  
  OBJECTIVE
  Evaluate the literature concerning mortality effect, emergency department (ED) length of stay, radiation, and incidental findings associated with WBCT.
  
  
  CONCLUSIONS
  Physicians have historically relied upon history and physical examination to diagnose life-threatening injuries in trauma. Diagnostic imaging modalities including radiographs, ultrasound, and computed tomography have demonstrated utility in injury detection. Many centers routinely utilize WBCT based on the premise this test will improve mortality. However, WBCT may increase radiation and incidental findings when used without considering pre-test probability of actionable traumatic injuries. Studies supporting WBCT are predominantly retrospective and incorporate trauma scoring systems, which have significant design weaknesses. The recent REACT-2 trial randomized trauma patients with high index of suspicion for actionable injuries to WBCT versus selective imaging and found no mortality difference. Additional prospective trials evaluating WBCT in specific trauma subgroups (e.g. polytrauma) are needed to evaluate benefit. In the interim, the available data suggests clinicians should adopt a selective imaging strategy driven by history and physical examination.
  
  
  CONCLUSIONS
  While observational data suggests an association between WBCT and a benefit in mortality and ED length of stay, randomized controlled data suggests no mortality benefit to this diagnostic tool. The literature would benefit from confirmatory studies of the use of WBCT in trauma sub-groups to clarify its impact on mortality for patients with specific injury patterns.
authors.affiliation: San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States. Electronic address: brit.long@yahoo.com.
authors.forename: Brit
authors.initials: B
authors.lastname: Long
authors.affiliation: San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States. Electronic address: Michael.D.April@post.harvard.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: April
authors.affiliation: Residency Director, Emergency Medicine, SAUSHEC Associate Professor of Emergency Medicine, USUHS, United States.
authors.forename: Shane
authors.initials: S
authors.lastname: Summers
authors.affiliation: The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D004636:Emergency Service, Hospital; D055317:Evidence-Based Practice; D006801:Humans; D015601:Injury Severity Score; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D000069079:Radiation Exposure; D016032:Randomized Controlled Trials as Topic; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D051598:Whole Body Imaging / Q000009:adverse effects / Q000379:methods*
keywords: Computed tomography; Imaging; Pan scan; Trauma; Whole-body computed tomography