St. Emlyn´s - Simon Carley - July 19, 2016
"The whole body CT has become a commonplace strategy for trauma in the UK. When a trauma patient is in your emergency room, it’s a quick and accurate detection method for most injuries. The primary survey in the resus room is all well and good for the initially life threatening injury, but the CT detects so much more, and following a number of papers looking at injury detection and survival UK trauma centres are targetted to get patients to the CT scanner within 30 minutes of arrival in the ED (http://stemlynsblog.org/ttl-podcast-1-getting-ct-30-minutes/) This is a hard target to hit with the sick trauma patient, and cna become a bit mechanistic. It’s quite easy to request a whole body scan, but should that be our default position? Could we reduce radiation dose with selective imaging? Will total body CT reduce mortality or is it unnecessary exposure to radiation? Does a total body CT break the first rule of medicine: First do no harm. REACT 2 aims to answer these questions, an RCT of WBCT vs selective imaging. The abstract is below, but as ever we always recommend you read the full paper (sadly it’s not open access)..:
The bottom line
There is no difference in mortality outcome for trauma patients who have a total body CT compared to selective imaging. Total body CT scan does increase the patients exposure to radiation, but by an amount that is surprisingly small (on average). This may be because a large percentage of patients who have selective scans ended up with the equivalent of a total body CT. Total body CT does give the quickest answer but does not ultimately reduce time spent in the emergency department.
In other words it seems that both strategies work."