The Necessity of Whole-Body Computed Tomography Scanning in Patients Admitted to the Emergency Department Due to Blunt Trauma

Abstract

Background

Despite numerous studies in the trauma literature, there is no definitive indication score or model for the use of whole-body computed tomography (WBCT).

Objective

This study aims to determine clinical characteristics and assess trauma scores in predicting positive WBCT findings in emergency trauma patients.

Methods

This prospective observational study was conducted at a level I trauma center. Patients over the age of 18 who presented to the emergency department due to high-energy trauma and were indicated for WBCT were included. Demographic characteristics, injury mechanisms, vital signs, physical examination findings, and trauma scores (Injury Severity Score (ISS), Triage Revised Trauma Score (T-RTS), Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score of the patients were recorded.

Results

The study included 1363 patients. 75.7% (n = 1032) of the patients were male, with a mean age of 36 years. 36.8% (n = 502) of patients had a positive (+) WBCT. Falls > 5 meters (p = 0.002) and injury to more than 2 body regions (p = 0.009) were statistically significantly associated with a higher rate of (+) WBCT in trauma patients. Patients with (+) WBCT had statistically significantly higher mean pulse rate (p = 0.001), respiratory rate (p < 0.001), and shock index (p = 0.007), while the mean oxygen saturation was lower (p < 0.001). The CRAMS score demonstrated higher predictive power than the T-RTS (AUC: 0.618; 95% CI: 0.586–0.650; p < 0.001; cutoff: 7.5) for identifying the presence of CT findings.

Conclusions

In multitrauma patients, the indication for WBCT should be determined not only based on trauma mechanism but also by considering physical examination findings, vital signs, and trauma scores collectively.