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Fri Feb 24 09:41:02 GMT 2012

> Evidence to support total body CT in an a symptomatic patient does not exist.   

I would tend to disagree with that slightly. There is limited rather than non existent evidence. I cited a few papers and there are a few more out there. My reading is that the current state of the evidence is that total body (or vertex to symphysis) scan in patients based purely on mechanism of injury (whatever you take as your cut off for mechanism- in the paper I mentioned in the EMJ, I have seen a separate presentation by one of the authors and the cut off is pretty low) involves a substantial dose of radiation but picks up some significant injuries that would otherwise be undiagnosed. It is also likely that there is a false positive rate for diagnosis, although this does not seem to be being reported in the literature (there certainly are a number of studies showing significant false positive rates for clinically directed CT scan though). Effect on mortality is less well studied. There are a few fairly poor quality studies out there. My reading of these is that current evidence is of a trend to better outcomes yet not hitting statistical significance. So I'd put it as "Limited evidence, open to interpretation either way when taken as a whole" rather than "No evidence" at present.

Matt Dunn
Emergency Physician 
Warwick

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not again- total body CAT-ATLS