Use of total body tomography in patients with severe trauma: Is it effective and safe to define non-operative management?

Abstract

Introduction. Total body tomography (CT) in the evaluation of patients with severe trauma can be an effective and safe tool to decide between surgical and non-surgical treatment, but the diagnostic implications and risks associated with this technique are not yet clear. Methods. We included patients older than 15 years with severe trauma who underwent total CT. Safety, effectiveness, and efficiency were assessed by contrast media-induced nephropathy incidence parameters, total radiation dose per patient, proportion of cases in which total CT changed management, and delay in diagnosis. Results. We included 263 patients, 83% suffered blunt trauma and 17% suffered penetrating trauma. The severity of the injury was greater in the latter and, however, the closed trauma with hemodynamic instability presented with higher degrees of shock. 65% of patients received nonoperative selective treatment. Among the subgroups, there were no significant differences in time between admission to the emergency room and taking total CT (p=0.96) and, in most cases, the time between performing total CT and the diagnosis of presence or absence of wounds was less than 25 minutes. The median total radiation was below 20 mSv in all groups. There were no significant differences in mortality (p=0.17). Conclusion. Total CT is a safe and efficient tool to decide between surgical and non-surgical treatment in cases of severe trauma, regardless of the mechanism of injury or hemodynamic stability on admission.