Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

Autor: Delphine Garrigue, Marc Freysz, Jean-Michel Yeguiayan, Claire Bonithon-Kopp, Anabelle Yap, Claude Jacquot, Christine Binquet, Bruno Riou, Claude Martin
Přispěvatelé: Département de médecine d'urgence / SAMU - SMUR - CESU 21 (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Pôle Anesthésie Réanimation, CHU Grenoble, Centre de Traumatologie et Département d'Anesthésie Réanimation, Université de la Méditerranée - Aix-Marseille 2-Centre Hospitalier Universitaire Nord, Lipides - Nutrition - Cancer (U866) (LNC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Accueil des Urgences [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Pierre et Marie Curie - Paris 6 (UPMC), This study was supported by the Programme Hospitalier de Recherche Clinique 2003 of the French Ministry of Health (National PHRC), the Société Française d'Anesthésie Réanimation (SFAR), and the Centre Hospitalier Universitaire of Dijon., Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques ( CIC-EC ), Université de Bourgogne ( UB ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Accueil des Urgences, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], BMC, Ed., Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Adult
Male
medicine.medical_specialty
[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
[SHS.INFO]Humanities and Social Sciences/Library and information sciences
Critical Care and Intensive Care Medicine
Wounds
Nonpenetrating
[SHS.INFO] Humanities and Social Sciences/Library and information sciences
Cohort Studies
03 medical and health sciences
Young Adult
0302 clinical medicine
Intensive care
[ SHS.INFO ] Humanities and Social Sciences/Library and information sciences
[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
Medicine
Humans
030212 general & internal medicine
Prospective Studies
Young adult
Mortality
Prospective cohort study
Trauma Severity Indices
blunt trauma
[ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
business.industry
Mortality rate
Research
Disease Management
030208 emergency & critical care medicine
Middle Aged
3. Good health
Surgery
Blunt trauma
Propensity score matching
Injury Severity Score
Female
business
Tomography
X-Ray Computed
Cohort study
Zdroj: Critical Care
Critical Care, BioMed Central, 2012, 16 (3), pp.R101. ⟨10.1186/cc11375⟩
Critical Care, 2012, 16 (3), pp.R101. ⟨10.1186/cc11375⟩
Critical Care, BioMed Central, 2012, 16 (3), pp.R101. 〈10.1186/cc11375〉
ISSN: 1364-8535
1466-609X
DOI: 10.1186/cc11375⟩
Popis: International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.
Databáze: OpenAIRE
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