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Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®)

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objectives

Whole-body computed tomography (WBCT) plays an increasingly important role in the diagnostic assessment of trauma room patients. It is still unclear whether its use has led to changes of trauma room procedures and patient outcomes.

Methods

In a retrospective multi-centric study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®), we analysed patients with an ISS ≥ 9 between 2002 and 2013. Two periods of time, i.e. up to 3 years preceding (pre-WBCT) and up to 3 years following the introduction of the WBCT (WBCT-group), were assessed separately for every hospital (TR-DGU Project ID 2014-020).

Results

19,838 patients underwent treatment in 77 hospitals. Of these, 5621 were assigned to the pre-WBCT group and 11,307 to the WBCT group. Basic data did not differ relevantly. The time spent in the trauma room decreased from 77.9 min (pre-WBCT) to 63.3 min (WBCT). Following the introduction of the trauma scan, the number of diagnoses per patient increased from 4.6 to 5.1. The percentage of patients who underwent surgery immediately after the completion of trauma room procedures decreased from 44.5 to 39.1%. There was an increase in mortality from 15.7 to 15.9%.

Conclusions

Routine use of WBCT is not superior to a combination of conventional radiography, ultrasound and focused CT in terms of mortality. The entire process involving the introduction of the trauma scan and the further development of algorithms has caused changes that can be observed in the trauma room setting.

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Acknowledgements

The two first authors, Hans-Georg Palm and Martin Kulla, state that major parts of this article are based on a doctoral dissertation that will be submitted to the Medical School of the University of Ulm by Magdalena Wettberg. The authors would like to thank Klaus Efinger (Bundeswehrhospital Ulm, Department of Radiology, German Armed Forces) for his valuable comments and suggestions regarding the analysis and interpretation of data. Finally, we would like to thank Barbara Isenberg of the German Federal Office of Languages for its assistance in translating our manuscript.

Author information

Author notes

  1. Hans-Georg Palm and Martin Kulla contributed equally to the article.

Authors and Affiliations

  1. Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    H.-G. Palm, M. Wettberg, B. Friemert & P. Lang

  2. Department of Anaesthesiology and Intensive Care Medicine, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    M. Kulla

  3. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany

    R. Lefering

Authors
  1. H.-G. Palm
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  2. M. Kulla
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  3. M. Wettberg
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  4. R. Lefering
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  5. B. Friemert
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Consortia

TraumaRegistrer DGU®

Contributions

Patricia Lang, Martin Kulla and Hans-Georg Palm designed the study. Rolf Lefering analysed and interpreted the data with Martin Kulla, Patricia Lang, Bendikt Friemert, Magdalena Wettberg and Hans-Georg Palm. Martin Kulla and Hans-Georg Palm wrote the manuscript. Benedikt Friemert, Patricia Lang and Martin Kulla were providing scientific support and valuable advice working on the manuscript. All authors proofread the manuscript and revised it critically. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to P. Lang.

Ethics declarations

Conflict of interest

Hans-Georg Palm, Martin Kulla, Magdalena Wettberg, Rolf Lefering, Benedikt Friemert and Patricia Lang declare that they have no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Availability of data and materials

All data that are relevant for the study are included in this published article. Further datasets analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The present study is in line with the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU Project ID 2014-020. As register data are assessed anonymously, individual informed consent is not required.

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Palm, HG., Kulla, M., Wettberg, M. et al. Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®). Eur J Trauma Emerg Surg 44, 759–766 (2018). https://doi.org/10.1007/s00068-017-0870-y

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  • DOI: https://doi.org/10.1007/s00068-017-0870-y

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