Whole Body Computed Tomography for trauma patients in shock: a single centre, propensity score matched retrospective cohort study in a Swiss tertiary trauma centre

Abstract

Abstract Background: Trauma is one of the leading causes of death or long-term disability. The ATLS (Advanced Trauma Life Support) approach is generally accepted as the standard of care for the initial management of severely injured patients. While WBCT (Whole Body Computed Tomography) is still considered as contraindicated 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 mortality of unstable trauma patients undergoing a WBCT during the initial workup with those who did not. Methods: Single-centre retrospective observational study based on the local trauma registry from January 2008 to June 2020. We compared the 24-hour mortality of injured patients in circulatory shock undergoing WBCT with a control group undergoing standard workup only. Shock was defined as the simultaneous presence of a systolic blood pressure < 100 mmHg, Lactate>2.2 mmol/l and Base Excess <-2 mmol/l at admission. 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. Results: Of the 161 patients fulfilling the inclusion criteria, 132 underwent WBCT and 29 standard work-up only. In crude and matched analyses, no difference in early (24 hours) 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 hours in the WBCT group was 0.36 (95% CI 0.07-1.73); p=0.20. Conclusions: In the present study, WBCT did not increase the risk of death at 24 hours 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.