A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2)

The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness.The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group.ClinicalTrials.gov: (NCT01523626).Injuries are the cause of 5.8 million deaths annually which accounts for almost 10% of global mortality [1]. Among adults aged 15-59 years the proportion of injuries as cause of death is even higher, ranging from 22% to 29% [1]. Injuries, whether unintentional or intentional, may have devastating effects on the lives of individuals and poses a great burden on public-health budgets [2]. This burden may even increase in the future, sinc