CT-first resuscitation for severe blunt trauma: A propensity score-matched cohort study

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Radiology

Background:

• Unstable blunt trauma often delays whole-body computed tomography (WBCT) due to uncertain bleeding sources, potentially hindering timely hemorrhage control.
• CT-first resuscitation (CTFR) involves immediate WBCT in a equipped trauma resuscitation room with specific hemorrhage control triggers.

Purpose of the Study:

• To assess if CTFR is associated with differences in transfusion requirements, time to hemostatic intervention, and mortality in blunt trauma patients.

Main Methods:

• Retrospective cohort study (2019-2023) comparing CTFR at a single center with patients from the Japan Trauma Data Bank.
• 1:1 propensity score matching (n=248 per group) was used.
• Outcomes included 24-hour red blood cell (RBC) units, time to CT, time to first hemostatic intervention, and in-hospital mortality.

Main Results:

• CTFR significantly shortened time to CT initiation (0.4 vs. 29.0 min) and first hemostatic intervention (53.7 vs. 134.0 min).
• 24-hour RBC transfusion rates were similar, but adjusted RBC units were lower with CTFR (mean difference: -0.84 units).
• In-hospital mortality was similar between groups (9.7% vs. 8.9%). Exploratory analysis showed greater RBC reduction in shock patients with CTFR.

Conclusions:

• CTFR is associated with earlier WBCT and faster hemostatic interventions in blunt trauma.
• CTFR demonstrated modestly lower adjusted 24-hour RBC transfusion requirements with similar mortality rates.
• The benefits of CTFR, particularly reduced transfusion needs, were more pronounced in patients presenting with shock.