German researchers have found that patients who are in shock and were diagnosed with whole-body computed tomography (CT) imaging showed substantially lower mortality rates.
The data analysis from the Trauma Register of the German Trauma Society (DGU) was performed by Stefan Huber-Wagner, MD, and colleagues in close cooperation with Prof. Rolf Lefering, PhD, from the Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (Cologne, Germany).
Data of 16,719 severely injured patients from Germany, Belgium, Austria, Switzerland, and Slovenia were analyzed. The authors compared the observed and the expected mortality rate of severely injured patients with and without whole-body CT. The patients were divided in three groups: patients with severe shock, patients with moderate shock, and patients without shock.
In hemodynamically stable patients, the benefits of early whole-body CT were demonstrated before by this research group. However, the CT scanning in hemodynamically unstable patients is denied by many experts, although there was no scientific evidence so far. These specialists hold the view that physical assessment, basic traditional radiography and ultrasound are sufficient for patients in shock and that the use of whole-body CT leads to considerable time delay before emergency surgery.
Fifty-five percent of 9,233 patients (9,233) were studied with whole-body CT after admission to hospital. It takes between three and six minutes on average to conduct such an imaging scan. Eleven percent (1,821) of patients were in severe shock and 4,280 (26%) in moderate shock. Patients in shock, as reported, who were detected with whole-body CT showed significantly lower mortality rates. Furthermore, risk-adjusted mortality showed that the observed mortality in severely injured patients in shock was significantly lower with whole-body CT than the expected mortality, as compared to patients without whole-body CT. These calculations were based on the Revised Injury Severity Classification Score (RISC), which is a precise prognostic score in trauma care.
The authors concluded that their current hypothesis in trauma care is justified and furthermore found interesting insights regarding emergency treatment and requirements for trauma centers. According to their findings, the chance of survival in shock is increased by more than 25% if whole-body CT is performed. In spite of the supposed time delays caused by whole-body CT, the comprehensive knowledge of the complete injury pattern enables targeted life-saving emergency treatment. Strongly bleeding injuries can therefore be localized exactly and treated precisely. The cause shock can thereby be detected very quickly and accurately.
Prof. Peter Biberthaler, MD, director of the department of trauma surgery at University Hospital Klinikum rechts der Isar (Munich, Germany), emphasized, “With the required expertise, this innovative concept will probably lead to further decreased mortality rates of major trauma patients in the future.”
The study findings were published July 24, 2013, in the journal PLOS ONE.
Institute for Research in Operative Medicine, University of Witten/Herdecke