WHOLE BODY COMPUTED TOMOGRAPHY FOR BLUNT TRAUMA IS ASSOCIATED WITH DECREASED MORTALITY IN COMATOSE PATIENTS

Abstract

　　Whole-body computed tomography (WBCT) has been promoted for the management of blunt trauma (BT) in high-income countries. Japan advanced trauma evaluation and care (JATEC) guidelines recently allowed not only head but also WBCT for patients with life-threatening, central nervous dysfunction at the beginning of a secondary survey. We conducted this nationwide study to verify that JATEC statement. Japan Trauma Data Bank data (2007-2010) were used for comatose BT patients with systolic blood pressure>75mmHg. As probability of survival (Ps) by the Trauma and Injury Severity Score (TRISS) method was uesd for severity adjustment, 2,973 patients were analyzed without missing variables necessary for TRISS Ps calculation. WBCT was defined as CT including the head, neck, chest, abdomen, and pelvis during initial trauma management, and compared the WBCT group with patients without one or more CT of the body regions (non-WBCT). No significant difference in TRISS Ps was observed between the groups. However, the recorded mortality proportion was significantly lower (p<0.0001) in the WBCT group (0.34 [95% CI : 0.31-0.37]) than in the non-WBCT group (0.42, [0.39-0.44]). In Japan, integration of WBCT into initial trauma management may decrease mortality in comatose BT patients indicated for head CT.