Giving severe trauma victims a computed tomography (CT) scan before managing their bleeding could boost their chances of survival, suggests a study in the open access journal Critical Care. The findings are at odds with current guidelines, and so contribute to the on-going debate about how best to treat patients with severe trauma injuries.
Trauma is the leading cause of death in young adults in many countries, including England and Japan. Advanced Trauma Life Support (ATLS) guidelines, widely used in over sixty countries, state that after a quick 'first survey', resuscitation takes priority over advanced diagnostic procedures. If a patient is suffering from excessive bleeding, emergency surgery also precedes diagnostic scans. But this may not always be the most appropriate strategy, the study suggests.
Daiki Wada and colleagues performed a retrospective study of patients that had experienced blunt, non-penetrating trauma (normally caused by impact or physical attack). They compared those who received an early whole-body CT scan with those who did not, and found that CT scans performed before emergency bleeding control were associated with reduced mortality a month later. The effect was most pronounced in severe trauma patients. This is the first evidence, to the author's knowledge, to suggest that early, pre-operative CT scans can positively influence survival in high-risk trauma patients.
The scans can help clinicians decide what type of emergency bleeding control to use -- surgical or non-surgical. But they can also reveal unexpected sites of bleeding, helping clinicians to treat the patients more effectively.
Whole-body CT has gained importance in the early phases of trauma care, and has become an essential part of the trauma diagnostic work-up. In one previous study, whole-body CT scans altered the subsequent treatment of approximately one fifth of trauma patients without obvious external signs of injury. But the diagnostic value of CT for seriously injured patients has not been thoroughly evaluated, until now. Recent technological advances now mean that whole-body CT scans can take as little as a few minutes, yet the importance of this technology in early trauma management remains controversial.
- Daiki Wada, Yasushi Nakamori, Kazuma Yamakawa, Yoshiaki Yoshikawa, Takeyuki Kiguchi, Hiroshi Ogura, Yasuyuki Kuwagata, Takeshi Shimazu, Osamu Tasaki, Toshimitsu Hamasaki and Satoshi Fujimi. Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma. Critical Care, 2013 (in press) [link]
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