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The use of whole-body computed tomography in major trauma: variations in practice in UK trauma hospitals
  1. Ian Ayenga Sammy1,
  2. Hridesh Chatha3,
  3. Omar Bouamra2,
  4. Marisol Fragoso-Iñiguez2,
  5. Fiona Lecky1,
  6. Antoinette Edwards2
  1. 1 School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2 Trauma Audit and Research Network, University of Manchester, Manchester, UK
  3. 3 Emergency Department, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Ian Ayenga Sammy, TARN Doctoral Research Fellow, Director, MSc in Advanced Emergency Care, School of Health and Related Research, The University of Sheffield, UK; ian.sammy{at}sheffield.ac.uk, sammyian62{at}gmail.com

Abstract

Introduction Whole-body CT (WBCT) use in patients with trauma in England and Wales is not well documented. WBCT in trauma can reduce time to definitive care, thereby increasing survival. However, its use varies significantly worldwide.

Methods We performed a retrospective observational study of Trauma Audit and Research Network (TARN) data from 2012 to 2014. The proportion of adult patients receiving WBCT during initial resuscitation at major trauma centres (MTCs) and trauma units/non-designated hospitals (TUs/NDHs) was compared. A model was developed that included factors associated with WBCT use, and centre effects within the model were explored to determine variation in usage beyond that expected from the model.

Results Of the 115 664 study participants, 16.5% had WBCT. WBCT was performed five times more frequently in MTCs than in TUs/NDHs (31% vs 6.6%). In the multivariate model, increased injury severity, low GCS, shock, comorbidities and triage category increased the chances of having a WBCT, but there was no consistent relation with age. High falls and motor vehicle collisions also increased WBCT usage. Adjusting for casemix, there was a 13-fold intrahospital variation in the use of WBCT between MTCs and a 30-fold variation between TUs/NDHs. The amount of variability between individual hospitals that could not be accounted for by the factors shown to impact on WBCT use was 26% (95% CI 17% to 39%) for MTCs and 17% (95% CI 13% to 21%) for TUs/NDHs.

Conclusion There are significant variations in WBCT use between different hospitals in England and Wales, which require further investigation.

  • Emergency department
  • Imaging
  • CT/MRI
  • Major trauma management
  • Resuscitation
  • Trauma

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Footnotes

  • Contributors IS and HC conceived the original research idea, developed the research method and contributed to data analysis and interpretation. FL supervised and contributed substantially to the development of the research method and data interpretation. OB advised on the research method, analysed the data and contributed towards data interpretation. MF-I contributed to the development of the research methods, data analysis and interpretation and AE contributed to the development of the research methods and data interpretation. All authors contributed substantially to the preparation of the final manuscript.

  • Funding TARN is funded by subscription from its member hospitals in England, Wales, Republic of Ireland, Denmark and Switzerland.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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