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Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a
Yusuke Tsutsumi1,2, Shingo Fukuma1, Asuka Tsuchiya3,2
1Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Insights
Computed tomography (CT) did not show harmful effects on survival for unstable blunt trauma patients. This finding suggests CT may be a valuable diagnostic tool even in critical cases.
Area of Science:
- Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Hemodynamically unstable trauma patients often undergo computed tomography (CT) to identify bleeding sources.
- Current guidelines offer limited recommendations for CT use in this patient population.
- The safety and efficacy of CT in unstable blunt trauma patients require further investigation.
Purpose of the Study:
- To examine the association between computed tomography (CT) use during initial management and in-hospital mortality.
- To clarify potential harmful effects of CT in hemodynamically unstable blunt trauma patients.
Main Methods:
- Retrospective cohort study using the Japan Trauma Data Bank (2004-2014).
- Included adult blunt trauma patients presenting with hypotension.
- Propensity score inverse probability of treatment weighted (IPTW) and instrumental variable (IV) analyses were performed to adjust for confounders.
Main Results:
- Of 5,809 patients, 92.1% underwent CT.
- The CT group exhibited less severe physiological conditions and higher survival probability compared to the no-CT group.
- IPTW analysis indicated a protective effect of CT on mortality (excess deaths: -20.6 per 100 patients).
- IV analysis revealed no statistically significant association between CT and mortality (excess deaths: -4.1 per 100 patients).
Conclusions:
- No clinically meaningful harmful effect of CT on survival was observed in unstable blunt trauma patients.
- Results challenge current guideline recommendations, suggesting CT is a viable diagnostic option.
- Physicians may consider CT for unstable patients to identify bleeding sources.
Background:
Although many hemodynamically unstable trauma patients undergo computed tomography (CT) to identify a source of bleeding, this practice is currently only recommended by a few guidelines. To clarify whether CT has harmful effects among these patients, we examined the association between CT during initial management and mortality among unstable blunt trauma patients.
Methods:
This was a retrospective cohort study based on Japan Trauma Data Bank 2004-2014 registry data. Study population was adult blunt trauma patients with hypotension on arrival. The primary outcome was the in-hospital mortality. Two types of analyses were performed to adjust for confounding factors including propensity score inverse probability of treatment weighted (IPTW) and instrumental variable (IV) analysis.
Results:
Among 5,809 patients who met inclusion criteria, 5,352 (92.1%) underwent CT. The No CT group was more likely to have severe physiological conditions and lower probability of survival than those of the CT group. In IPTW analysis adjusting for measured confounders, we found a significant protective effect of undergoing CT on in-hospital mortality (excess deaths: -20.6 per 100 patients, 95% CI -26.2 to -14.9). In IV analysis adjusting both for measured and unmeasured confounders, the association between CT and mortality was not statistically significant (excess deaths: -4.1 per 100 patients, 95% CI -23.1 to 14.8).
Discussion:
We did not find clinically meaningful harmful effect of CT on survival for unstable blunt trauma patients even after adjusting both for measured and unmeasured confounders.
Conclusions:
Our results did not support the recommendation of current guideline. We suggest physicians should consider CT as one of the diagnostic options even when patients are unstable.
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