The Necessity of Whole-Body Computed Tomography Scanning in Patients Admitted to the Emergency Department Due to Blunt Trauma
Journal of Emergency Medicine, cilt.78, ss.291-301, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 78
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.jemermed.2025.08.012
- Dergi Adı: Journal of Emergency Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.291-301
- Anahtar Kelimeler: Emergency, Multiple trauma, Trauma score, Whole-body computed tomography
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Despite numerous studies in the trauma literature, there is no definitive indication score or model for the use of whole-body computed tomography (WBCT). Objective: This study aims to determine clinical characteristics and assess trauma scores in predicting positive WBCT findings in emergency trauma patients. Methods: This prospective observational study was conducted at a level I trauma center. Patients over the age of 18 who presented to the emergency department due to high-energy trauma and were indicated for WBCT were included. Demographic characteristics, injury mechanisms, vital signs, physical examination findings, and trauma scores (Injury Severity Score (ISS), Triage Revised Trauma Score (T-RTS), Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score of the patients were recorded. Results: The study included 1363 patients. 75.7% (n = 1032) of the patients were male, with a mean age of 36 years. 36.8% (n = 502) of patients had a positive (+) WBCT. Falls > 5 meters (p = 0.002) and injury to more than 2 body regions (p = 0.009) were statistically significantly associated with a higher rate of (+) WBCT in trauma patients. Patients with (+) WBCT had statistically significantly higher mean pulse rate (p = 0.001), respiratory rate (p < 0.001), and shock index (p = 0.007), while the mean oxygen saturation was lower (p < 0.001). The CRAMS score demonstrated higher predictive power than the T-RTS (AUC: 0.618; 95% CI: 0.586–0.650; p < 0.001; cutoff: 7.5) for identifying the presence of CT findings. Conclusions: In multitrauma patients, the indication for WBCT should be determined not only based on trauma mechanism but also by considering physical examination findings, vital signs, and trauma scores collectively.