Computed tomography in initially unstable thoracoabdominal trauma can safely enhance triage

Computed tomography (CT) imaging of hemodynamically abnormal trauma patients undergoing aggressive resuscitation is controversial. Our study investigated outcomes for hemodynamically abnormal thoracoabdominal trauma undergoing CT prior to definitive therapy.

Hemodynamically abnormal (HR≥120 bpm, SBP<90 mmHg) patients arriving to our Level I trauma center between 2015 and 2022 were reviewed. Patients with thoracoabdominal trauma achieving hemodynamic improvement (SBP≥90 mmHg) were included. Pediatric patients, pregnant patients, and traumatic arrests were excluded. After matching for baseline characteristics, CT findings, and operative details, clinical outcomes were tabulated. Primary outcomes included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), ventilator days and mortality. Secondary outcomes included intraoperative data, transfusions, additional procedures, and complications.

A total of 235 patients met inclusion criteria. Thirty-six (15 %) were triaged directly to the OR while 199 (85 %) went to CT. The CT and OR groups were matched for injury burden (mean ISS OR group=21±2.6 vs. CT group=18.4 ± 0.8, p = 0.24). Overall, no difference in HLOS (p = 0.3), ICU LOS (p = 0.9), time on ventilator (p = 0.4) or mortality (p = 0.5) was observed. Patients undergoing CT needed less PRBCs (9.0 ± 2.6 vs. 3.4 ± 0.7 units) and FFP (5.1 ± 1.9 vs. 1.6 ± 0.4 units). The OR group patients had a higher probability of needing to undergo additional procedures (36 % vs. 12 %).

Hemodynamically abnormal thoracoabdominal trauma patients who are resuscitated to a SBP≥90 mmHg can safely undergo CT prior to definitive therapy.