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Mortality With and Without Whole-Body CT in Severely Injured Children
Mathias Berger1, Rolf Lefering, Michael Bauer
1University Hospitals of Friedrich-Schiller-University Jena and Department of Anesthesiology and Intensive Care Medicine, Elisabeth-Hospital Halle (Saale); Institute for Research in Operative Medicine (IFOM) Cologne Campus Merheim, Witten/Herdecke University; Department of Anesthesiology and Intensive Care Medicine, University Hospitals of Friedrich-Schiller-University Jena; Clinic for Trauma-, Handand Reconstructive Surgery, University Hospitals of Friedrich-Schiller-University Jena and Clinic for Traumaand Reconstructive Surgery, Bergmannstrost BG-Hospital Halle (Saale); Institute of Diagnostic and Interventional Radiology and Neuroradiology, Heinrich-Braun-Clinic Zwickau; Department of Anesthesiology, Intensive Care, Bergmannstrost BG-Hospital Halle (Saale).
Insights
Whole-body computed tomography (WB-CT) does not improve outcomes for severely injured children. Current data show no survival benefit compared to step-wise diagnosis, despite risks of radiation exposure.
Area of Science:
- Trauma Surgery
- Pediatric Imaging
- Radiology
Background:
- The optimal imaging strategy for pediatric trauma patients remains debated.
- Whole-body computed tomography (WB-CT) is increasingly used, but its benefit in children requires evaluation.
- This study utilizes data from the German Trauma Registry (TR-DGU) to assess WB-CT's impact on outcomes in injured children.
Purpose of the Study:
- To investigate whether whole-body computed tomography (WB-CT) improves survival rates in severely injured children.
- To compare outcomes of WB-CT versus step-wise diagnostic procedures in pediatric trauma care.
- To analyze mortality predictors and perform propensity score matching for a robust comparison.
Main Methods:
- Analysis of data from the TR-DGU registry (2012-2021).
- Comparison of mortality between children and adults (≤50 years).
- Propensity score analysis of matched pairs comparing WB-CT and step-wise diagnosis in children.
Main Results:
- No significant difference in observed to expected mortality ratio between children who received WB-CT (SMR 0.97) and those who did not (SMR 0.95).
- Propensity score analysis of 1101 matched pairs showed similar mortality rates (3.9% with WB-CT vs. 4.0% without).
- WB-CT showed a survival advantage in adults, but not in children.
Conclusions:
- Whole-body computed tomography (WB-CT) does not demonstrate a survival benefit for severely injured children compared to a step-wise diagnostic approach.
- The potential risks of radiation exposure and induced malignancy in children necessitate careful consideration of WB-CT benefits versus risks.
- Clinical decisions regarding WB-CT in pediatric trauma should involve thorough team discussions weighing benefits against harms.
Background:
The choice of imaging modality-the use of whole-body computed tomography (WB-CT) versus a step-wise diagnostic procedure-in injured children is controversial. In this study we availed ourselves of data from the TR-DGU, the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie), to investigate whether the use of WB-CT improves the outcome.
Methods:
The TR-DGU data from the period 2012-2021 were evaluated. A three-stage analysis began with comparison of children with adults aged ≤ 50 years. As a second step, the observed and expected mortality in children with WB-CT was compared with the mortality in children without WB-CT. Finally, predictors of the use of WB-CT were identified so that a propensity score analysis of matched pairs could be performed.
Results:
A total of 65 092 patients were included, 4573 children (7%) and 60 519 adults (93%), with differences in accident type and injury pattern. Comparison of the ratio of observed to expected mortality revealed no difference between the two groups of children (standardized mortality ratio 0.97 with WB-CT, 0.95 without WB-CT). In adults, however, there was an advantage for the WB-CT group. The propensity score analysis of 1101 matched pairs showed identical mortality in the two groups (3.9% with WB-CT, 4.0% without WB-CT).
Conclusion:
The TR-DGU data show no benefit of WB-CT compared with step-wise diagnosis in the care of severely injured children. In view of the radiation exposure involved, with the danger of inducing malignancy, the benefits and risks of the use of WB-CT in children should be weighed up carefully in team discussions.
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