List Archives

Thu Oct 8 14:26:48 BST 2009

Dear list members,

We are looking for co-investigators in a multicenter trial in which immediate total body CT scanning is compared with conventional X-ray imaging supplied with (selective) CT scanning in severely injured patients. If you are interested, please continue reading. 

Total body CT scanning (TBCT) is increasingly being used in severely injured patients. The current available evidence on clinical outcomes seems promising but is of low quality level. Most studies on TBCT were retrospective cohort studies or prospective studies with small populations and sub-clinical outcome measures. We feel that better research on both the advantages as well as side effects of TBCT is required before a wide adaptation of this strategy can be recommended.

In a multidisciplinary research group a protocol was developed for a multicenter RCT in which the effects of immediate TBCT, without preceding X-ray imaging or FAST, will be compared with the conventional ATLS imaging guidelines with selective CT scanning. Inclusion criteria are based on compromised vital parameters or suspicion on specific severe injuries. Primary outcome is 30 day mortality; 539 patients per group are required. Funding is currently being sought.

During our search for co-investigators we experienced difficulties finding trauma centers that have the facilities to meet our safety requirements for participation: a CT scanner, resuscitation equipment, and facilities for conventional imaging all in one room. Some centers that did have the appropriate equipment were already convinced on the available evidence and were not willing to perform the conventional arm anymore in severely injured patients.

If anyone is interested in receiving more information on participation in this RCT please do not hesitate to contact us off list.

With kind regards,

Carel Goslings, MD, PhD
Teun-Peter Saltzherr, MD

Academic Medical Center
Trauma Unit dept. Surgery
Amsterdam, Netherlands

References:
1)	Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009 Apr 25;373(9673):1455-61. Huber-Wagner S et al.
2)	Comments: Lancet. 2009 Apr 25;373(9673):1455-61

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