The association between timing of CT and outcomes for severe trauma patients: analysis of a nationwide trauma registry.

Abstract

Purpose: With advances in technology, early computed tomography (CT) scanning is advocated for trauma patients. However, the benefits of early CT scanning remain unclear. Thus, we examined whether time elapsed from hospital arrival to CT acquisition is associated with the prognoses of severe trauma patients.

Methods: We utilized the Japan Trauma Data Bank, a nationwide database. Patients directly transferred from the trauma scene were included. Severe trauma patients, defined as those with Injury Severity Scores (ISS) greater than 15, were enrolled. We excluded patients with cardiac arrest on hospital arrival, ISS of 75, missing data on timing of CT, inappropriate CT time, and elapsed time from hospital arrival to CT scan longer than or equal to 60 min, as well as those who required damage control surgery and those who died within 24 h. Patients were divided into six groups based on elapsed time to CT acquisition (0-9, 10-19, 20-29, 30-39, 40-49, 50-59 min.). The primary outcome was in-hospital mortality, and the secondary outcome was amount of transfusion, including red blood cells, fresh frozen plasma, and platelets.

Results: Of the registered trauma cases, 13,802 cases were included in this study. The crude proportion of in-hospital mortality in the 0-9 min. group was the highest (15.4% [138/898]) compared to other groups. Compared to the 0-9 min. group, multivariable logistic regression analysis revealed that the earlier elapsed time to CT acquisition did not contribute to the improved rate of in-hospital mortality (10-19 min.; OR 0.84, 95% CI 0.64-1.09, p = 0.19, 20-29 min.; OR 0.89, 95% CI 0.69-1.16, p = 0.39, 30-39 min.: OR 0.88, 95% CI 0.67-1.16, p = 0.36, 40-49 min.: OR 0.92, 95% CI 0.67-1.26, p = 0.60, 50-59 min.: OR 1.03, 95% CI 0.73-1.46, p = 0.85). Transfusion amounts did not differ between groups.

Conclusion: Early CT scanning after hospital arrival did not contribute to improved in-hospital mortality or reduce the transfusion amount for severe trauma patients.