Original Scientific Report

Whole-Body Computed Tomography During Initial Management and Mortality Among Adult Severe Blunt Trauma Patients: A Nationwide Cohort Study

Yusuke Tsutsumi

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

Department of Emergency Medicine, National Hospital Organization Mito Medical Center, 280 Sakuranosato Ibaraki-machi, 311-3117 Higashiibaraki-gun, Ibaraki, Japan

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Shingo Fukuma,

Corresponding Author

Shingo Fukuma

[email protected]
81-75-751-3925

orcid.org/0000-0002-8379-8761

Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Yoshida-Kawahara-machi, Sakyo-ku, 606-8507 Kyoto, Japan

Tel.: 81-75-751-3925, [email protected]Search for more papers by this author

Asuka Tsuchiya,

Asuka Tsuchiya

Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan

Department of Emergency Medicine, National Hospital Organization Mito Medical Center, 280 Sakuranosato Ibaraki-machi, 311-3117 Higashiibaraki-gun, Ibaraki, Japan

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Yosuke Yamamoto,

Yosuke Yamamoto

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

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Shunichi Fukuhara,

Shunichi Fukuhara

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

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Yusuke Tsutsumi,

Yusuke Tsutsumi

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

Department of Emergency Medicine, National Hospital Organization Mito Medical Center, 280 Sakuranosato Ibaraki-machi, 311-3117 Higashiibaraki-gun, Ibaraki, Japan

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Shingo Fukuma,

Corresponding Author

Shingo Fukuma

[email protected]
81-75-751-3925

orcid.org/0000-0002-8379-8761

Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Yoshida-Kawahara-machi, Sakyo-ku, 606-8507 Kyoto, Japan

Tel.: 81-75-751-3925, [email protected]Search for more papers by this author

Asuka Tsuchiya,

Asuka Tsuchiya

Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan

Department of Emergency Medicine, National Hospital Organization Mito Medical Center, 280 Sakuranosato Ibaraki-machi, 311-3117 Higashiibaraki-gun, Ibaraki, Japan

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Yosuke Yamamoto,

Yosuke Yamamoto

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

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Shunichi Fukuhara,

Shunichi Fukuhara

Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, 606-8501 Kyoto, Japan

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First published: 29 June 2018

https://doi.org/10.1007/s00268-018-4732-5

Citations: 16

Electronic supplementary material: The online version of this article (https://doi.org/10.1007/s00268-018-4732-5) contains supplementary material, which is available to authorized users.

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Abstract

Background

Whole-body computed tomography (WBCT) is increasingly being incorporated into the initial management of blunt trauma patients. Several observational studies have suggested that, compared to selective CT, WBCT is associated with lower mortality. In contrast, a randomized controlled trial found no significant difference in survival between patients undergoing WBCT compared to selective CT. Our objective was to confirm the association between WBCT and in-hospital mortality among adult severe blunt trauma patients.

Methods

This was a retrospective cohort study based on Japan Trauma Data Bank 2004–2015 registry data. The study population comprised adult severe blunt trauma patients with at least one abnormal vital sign: systolic blood pressure ≤100 mmHg, heart rate ≥120, respiratory rate ≥30 or ≤10, or Glasgow Coma Score ≤13. The primary outcome was in-hospital mortality. To adjust for both measured and unmeasured confounders, we performed instrumental variable (IV) analysis to compare the in-hospital mortality of patients undergoing WBCT with those undergoing selective CT.

Results

Of 40,435 patients who were eligible for this study, 19,766 (48.9%) patients underwent WBCT. The proportion of patients undergoing WBCT significantly increased during the study period, from 10.7% in 2004 to 59.6% in 2015. Primary IV analysis showed a significant association between WBCT and lower in-hospital mortality (odds ratio 0.84, 95% confidence interval 0.72–0.98).

Conclusions

WBCT can be beneficial in patients with blunt trauma which has compromised vital signs. These findings from a nationwide study suggest that physicians should consider WBCT for blunt trauma patients when warranted by vital signs.

Supporting Information

References

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Volume42, Issue12

December 2018

Pages 3939-3946

Filename	Description
wjsbf09110-sup-0001.pdfPDF document, 67.3 KB	Supplementary material 1 (PDF 67 kb)
wjsbf09110-sup-0002.pdfPDF document, 22.2 KB	Supplementary material 2 (PDF 22 kb)
wjsbf09110-sup-0003.pdfPDF document, 84.4 KB	Absolute standardized differences in measured confounders between IV and actual treatment. IV, instrumental variable; ISS, injury severity score (PDF 84 kb)

Whole-Body Computed Tomography During Initial Management and Mortality Among Adult Severe Blunt Trauma Patients: A Nationwide Cohort Study

Abstract

Background

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

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Whole-Body Computed Tomography During Initial Management and Mortality Among Adult Severe Blunt Trauma Patients: A Nationwide Cohort Study

Abstract

Background

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

Related

Information