A meta-analysis of the efficacy of whole-body computed tomography imaging in the management of trauma and injury

Background: Traumatic injury is the third leading cause of death overall. To optimize the outcomes in these patients, hospitals employ whole-body computed tomography (WBCT) imaging due to the high diagnostic yield and potential to identify missed injuries. However, this delays time-critical interventions. Currently, there is an absence of any high-level evidence to support or refute either view. We present a meta-analysis of the available literature to elucidate the efficacy of WBCT in improving the outcomes of trauma, specifically the mortality rate. Methods: A systematic review of studies comparing WBCT and selective CT imaging in secondary survey was conducted, using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. The articles were evaluated for intervention using WBCT to reduce mortality rate, followed by subgroup analysis for other secondary measures, using Review Manager 5.3 software. Results: Eleven studies of 32,207 patients were included. There were lower overall (OR = 0.79; 95% CI 0.74,0.83, p< 0.05) and 24 h mortality rates (OR = 0.72, 95% CI 0.66,0.79, p< 0.05) in the WBCT cohort. Additionally, patients in the WBCT arm spent less time in the emergency room (MD= -14.81; 95% CI -17.02, -12.60, p< 0.00001) and needing ventilation (MD= -2.01; 95% CI -2.41, -1.62, p< 0.05) despite a higher baseline injury severity score. Conclusion: The analysis shows that WBCT is associated with better outcomes, including a lower overall and 24 h mortality rate, however the included studies are mostly observational and show considerable heterogeneity. Further work is required to make definitive clinical recommendations for a tailored algorithm in managing trauma patients. Crown Copyright (C) 2017 Published by Elsevier Ltd. All rights reserved.