Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study

Background: The current common and dogmatic opinion is that whole-body computed tomography (WBCT) should not be performed in major trauma patients in shock. We aimed to assess whether WBCT during trauma-room treatment has any effect on the mortality of severely injured patients in shock. Methods: In a retrospective multicenter cohort study involving 16719 adult blunt major trauma patients we compared the survival of patients who were in moderate, severe or no shock (systolic blood pressure 90–110, 90 or.110 mmHg) at hospital admission and who received WBCT during resuscitation to those who did not. Using data derived from the 2002– 2009 version of TraumaRegisterH, we determined the observed and predicted mortality and calculated the standardized mortality ratio (SMR) as well as logistic regressions. Findings: 9233 (55.2%) of the 16719 patients received WBCT. The mean injury severity score was 28.8612.1. The overall mortality rate was 17.4 % (SMR = 0.85, 95%CI 0.81–0.89) for patients with WBCT and 21.4 % (SMR = 0.98, 95%CI 0.94–1.02) for those without WBCT (p,0.001). 4280 (25.6%) patients were in moderate shock and 1821 (10.9%) in severe shock. The mortality rate for patients in moderate shock with WBCT was 18.1 % (SMR 0.85, CI95 % 0.78–0.93) compared to 22.6 % (SMR 1.03, CI95 % 0.94–1.12) to those without WBCT (p,0.001, p = 0.002 for the SMRs). The mortality rate for patients in severe shock with WBCT was 42.1 % (SMR 0.99, CI95 % 0.92–1.06) compared to 54.9 % (SMR 1.10, CI95 % 1.02–1.16) to those withou