Early and Rapid Diagnosis with Multislice CT Reduces Lethality in Trauma Patients Requiring Intensive Care: Findings of a Prospective Study

Objective. The objective of this study was to investigate if short diagnostic times by MSCT have an influence on lethal outcomes. Methods. In three different patient populations, hospital mortality was examined. Group 1: retrospective data derived from conventional diagnostic methods in the trauma room between 2002 and 2003; group 2: data from the same centre taken prospectively between 2004 and 2010 after modification of the trauma room algorithm; group 3: a reference population from the TraumaRegister DGU (TR-DGU) from 2004 to 2010. Injury severity was determined using the ISS and lethality was predicted on the basis of the RISC. Results. At the singular centre, data from 943 polytraumatised patients requiring intensive care between 2002 and 2010 were examined. With the new trauma room algorithm, lethality was likewise significantly lower (9.1% versus 15%; ) compared to the population from 2002 to 2003, with a comparable ISS (28.5 versus 30.2). The ISS (28.5) was comparable with the TR-DGU (24.9) population and lethality was significantly lower. Conclusion. Early diagnostic approaches using MSCT during the first minutes of trauma room treatment, as an integral part of a stringently timed, highly structured concept, have been found to reduce lethality as compared to the TR-DGU and our own retrospective historical data. This trial is registered with DRKS00005055; TR-DGU-Projekt-ID: 2009-005. 1. Introduction Recent studies have demonstrated that the majority of deaths occurring in patients within 24 hours after suffering critical injuries can be attributed to bleeding and traumatic brain injury (TBI) [1]. Bleeding is the most common cause of death during the first three hours; for example, severe TBI is the leading cause in the subsequent hours [2]. In order to counter such causes of death therapeutically, a rapid diagnostic approach is essential. A current study in USA has revealed that at a level 1 trauma centre, critical injuries were overlooked in 21% and less critical injuries in 33% of the patients who had died [3]. This underlines the importance of undertaking thorough diagnostic imaging procedures as quickly as possible. Moving on from previous bimodal concepts that employed projection radiography and computed tomography, we have developed a treatment concept that involves only early multislice whole-body CT in the trauma room. The combination of multidetector row CT and table feed offered by modern CT equipment on the one hand permits excellent -axis resolution with slices of 1？mm thick and on the other hand allows scans of up to 1.80？m in