… and redeems them for valuable prizes.
Such is the message of this systematic review and meta-analysis, evaluating the published literature comparing “whole body CT”, arbitrary complete scanning, with “selective imaging”, scanning as indicated by physical examination.
Identifying seven studies, comprising 23,172 patients, these authors found a 20% reduction in mortality – 20.3% versus 16.9% – associated with the use of WBCT, despite a higher mean Injury Severity Score in the WBCT cohort. The implication: choosing a selective scanning strategy was harmful, even in the face of a less-injured cohort. Thus, the authors conclude the mortality advantage far exceeds any risks from radiation, and WBCT should be considered the standard method of evaluation.
Except, all but 2,610 of the patients in these pooled studies are from retrospective cohorts fraught with selection bias. There are many reasons why trauma patients with lower ISS might yet have higher mortality, and otherwise aggressive diagnostic evaluation not indicated. And, when those retrospective patients are tossed out, the comparison is a wash in the prospectively studied cohort.
If you’re a fan of selective imaging, this study probably changes little in your mind. If you’re a fan of WBCT, it’s another citation to add to your quiver. The authors of this study are hoping REACT-2 gives us the definitive answer – but with only 1,000 patients, I doubt that will be the case, either.
“Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: A systematic review and meta-analysis”
http://www.ncbi.nlm.nih.gov/pubmed/25250591