List Archives

Thu Oct 8 16:05:59 BST 2009

Considering the previous documentation of a significant whole body  
radiation burden from this kind of CT scanning, will the registry track the  
patients long enough to document the expected increase in blood, lymphatic and  
thyroid dyscrasias and frank neoplasms? or will the registry just look at 
short  term side effects?

ck

In a message dated 10/8/2009 07:27:38 Central Standard Time,  
t.p.saltzherr at amc.uva.nl writes:

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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