Effect Of Whole-body CT During The Early Resuscitation On Clinical Prognosis And Outcome Of Patients With Severe Multiple Trauma.

Objective To explore the effect of whole-body CT (WBCT) during the early resuscitation on clinical progression and outcome of patients with severe multiple trauma and to assess its role in early diagnosis and treatment of patients with severe multiple trauma.Methods1. Patients with severe blunt multiple trauma admitted to our general ICU from March 2007 ~ February 2010 were retrospectively analyzed. Inclusion criteria:①aged > 16 years;②multiple trauma;③ISS > 16 points;④patients were admitted from operating room or the emergency department directly;⑤patients were initially admitted to surgical department, but transferred to general ICU within 72 hours because of disease progression. Exclusion criteria:①patients had received treatment by emergency department of other hospital or had been hospitalized in other hospital before being transferred to our hospital;②patients with serious underlying diseases recently.2. We designed " Diagnosis and treatment survey form of patients with severe multile trauma during general ICU" and " Diagnosis and treatment Survey form of patients with severe multile trauma during the early resuscitation". Data on diagnosis and treatment of all patients meeting criteria were collected.3. According to whether lining Whole-body CT during the early resuscitation, all patients were divided into the non-whole-body CT (N-WBCT) group and WBCT group. Clinical parameters included of age, gender, Injury mechanism, ISS, GCS, APACHE II score, anatomy sites of CT, length of CT imaging, length of staying in emergency department, accidents, missed injuries, the duration of mechanical ventilation, length of staying in general ICU and mortality were observed. 4. Data processing: means between two groups were compared using t test or Mann-Whitney U test according to the distribution of data, dichotomous data were analyzed by Chi-square analysis. Statistical significance was defined at p<0.05. Results 1. A total of 187 patients were enrolled. Of these, there were 122 cases in N-WBCT group and 65 cases in WBCT group.2. There were no statistical differences in age, gender, Injury mechanism, ISS, APACHE II score, length of CT imaging and length of staying in emergency department between two groups. WBCT group were higher ISS than N-WBCT group ( P = 0.010 ). WBCT group were lower GCS than N-WBCT group (P = 0.028).3. There were statistical differences in the duration of mechanical ventilation (9.58±13.35 days vs 5.97±8.06 days, P = 0.047)and length of staying in general ICU (12.62±13.46 days vs 8.97±8.66 days, P = 0.049) between two groups, But there was no significant difference on the mortality between two groups.4. 28 patients had missed injuries in N-WBCT group. There were a total of 44 missed injuries in these patients, 13 missed injuries had significant clinical significance. only 7 cases in WBCT group, and there were a total of 11 missed injuries in these patients, 4 missed injuries had significant clinical significance. The incidence of missed injuries between two groups had a statistical difference (P = 0.049). There were no significantly clinical accidents in the process of transferring and Whole-body CT imaging.Conclusion Whole-body CT during the early resuscitation did not increase risks of transferring accidents for patients with severe multiple trauma, and reduce the incidence of missed injuries and shortened the duration of mechanical ventilation and length of staying in general ICU.