The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock
Abstract The Advanced Trauma Life Support (ATLS) approach is generally accepted as the standard of care for the initial management of severely injured patients. While whole body computed tomography (WBCT) is still considered a contraindication in haemodynamically unstable trauma patients, there is a...
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| Format: | Article |
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Nature Portfolio
2024-01-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-024-52657-5 |
| _version_ | 1827329152336789504 |
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| author | Ivana Hanzalova Mylène Bourgeat Nicolas Demartines François-Xavier Ageron Tobias Zingg |
| author_facet | Ivana Hanzalova Mylène Bourgeat Nicolas Demartines François-Xavier Ageron Tobias Zingg |
| author_sort | Ivana Hanzalova |
| collection | DOAJ |
| description | Abstract The Advanced Trauma Life Support (ATLS) approach is generally accepted as the standard of care for the initial management of severely injured patients. While whole body computed tomography (WBCT) is still considered a contraindication in haemodynamically unstable trauma patients, there is a growing amount of data indicating the absence of harm from cross sectional imaging in this patient group. Our study aimed to compare the early mortality of unstable trauma patients undergoing a WBCT during the initial workup with those who did not. Single-center retrospective observational study based on the local trauma registry including 3525 patients with an ISS > 15 from January 2008 to June 2020. We compared the 24-h mortality of injured patients in circulatory shock undergoing WBCT with a control group undergoing standard workup only. Inclusion criteria were the simultaneous presence of a systolic blood pressure < 100 mmHg, lactate > 2.2 mmol/l and base excess < − 2 mmol/l as surrogate markers for circulatory shock. To control for confounding, a propensity score matched analysis with conditional logistic regression for adjustment of residual confounders and a sensitivity analysis using inverse probability weighting (IPW) with and without adjustment were performed. Of the 3525 patients, 161 (4.6%) fulfilled all inclusion criteria. Of these, 132 (82%) underwent WBCT and 29 (18%) standard work-up only. In crude and matched analyses, no difference in early (24 h) mortality was observed (WBCT, 23 (17.4%) and no-WBCT, 8 (27.6%); p = 0.21). After matching and adjustment for main confounders, the odds ratio for the event of death at 24 h in the WBCT group was 0.36 (95% CI 0.07–1.73); p = 0.20. In the present study, WBCT did not increase the risk of death at 24 h among injured patients in shock. This adds to the growing data indicating that WBCT may be offered to trauma patients in circulatory shock without jeopardizing early survival. |
| first_indexed | 2024-03-07T15:29:46Z |
| format | Article |
| id | doaj.art-78fac0090149488ea510db6f51208838 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-07T15:29:46Z |
| publishDate | 2024-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-78fac0090149488ea510db6f512088382024-03-05T16:30:12ZengNature PortfolioScientific Reports2045-23222024-01-0114111010.1038/s41598-024-52657-5The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shockIvana Hanzalova0Mylène Bourgeat1Nicolas Demartines2François-Xavier Ageron3Tobias Zingg4Department of Surgery, Lausanne University Hospital (CHUV) and Lausanne UniversityDepartment of Surgery, Lausanne University Hospital (CHUV) and Lausanne UniversityDepartment of Surgery, Lausanne University Hospital (CHUV) and Lausanne UniversityDepartment of Emergency Medicine, Lausanne University Hospital (CHUV) and Lausanne UniversityDepartment of Surgery, Lausanne University Hospital (CHUV) and Lausanne UniversityAbstract The Advanced Trauma Life Support (ATLS) approach is generally accepted as the standard of care for the initial management of severely injured patients. While whole body computed tomography (WBCT) is still considered a contraindication in haemodynamically unstable trauma patients, there is a growing amount of data indicating the absence of harm from cross sectional imaging in this patient group. Our study aimed to compare the early mortality of unstable trauma patients undergoing a WBCT during the initial workup with those who did not. Single-center retrospective observational study based on the local trauma registry including 3525 patients with an ISS > 15 from January 2008 to June 2020. We compared the 24-h mortality of injured patients in circulatory shock undergoing WBCT with a control group undergoing standard workup only. Inclusion criteria were the simultaneous presence of a systolic blood pressure < 100 mmHg, lactate > 2.2 mmol/l and base excess < − 2 mmol/l as surrogate markers for circulatory shock. To control for confounding, a propensity score matched analysis with conditional logistic regression for adjustment of residual confounders and a sensitivity analysis using inverse probability weighting (IPW) with and without adjustment were performed. Of the 3525 patients, 161 (4.6%) fulfilled all inclusion criteria. Of these, 132 (82%) underwent WBCT and 29 (18%) standard work-up only. In crude and matched analyses, no difference in early (24 h) mortality was observed (WBCT, 23 (17.4%) and no-WBCT, 8 (27.6%); p = 0.21). After matching and adjustment for main confounders, the odds ratio for the event of death at 24 h in the WBCT group was 0.36 (95% CI 0.07–1.73); p = 0.20. In the present study, WBCT did not increase the risk of death at 24 h among injured patients in shock. This adds to the growing data indicating that WBCT may be offered to trauma patients in circulatory shock without jeopardizing early survival.https://doi.org/10.1038/s41598-024-52657-5 |
| spellingShingle | Ivana Hanzalova Mylène Bourgeat Nicolas Demartines François-Xavier Ageron Tobias Zingg The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock Scientific Reports |
| title | The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock |
| title_full | The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock |
| title_fullStr | The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock |
| title_full_unstemmed | The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock |
| title_short | The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock |
| title_sort | use of whole body computed tomography does not lead to increased 24 h mortality in severely injured patients in circulatory shock |
| url | https://doi.org/10.1038/s41598-024-52657-5 |
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