One Size Does Not Fit All: Is Whole-Body Computed Tomography Beneficial for All Patients with Suspected Major Trauma? A Prospective Randomized Controlled Trial
Erh-Hao Liu, Yi-Wen Hong, Yon-Cheong Wong, Chun-Hsiang Ou Yang, Jen-Fu Huang, Chih-Po Hsu, Chien-Hung Liao, Shih-Ching Kang, Shang-Yu Wang, I-Ming KuoIntroduction/Objective:
Whole-body computed tomography (WBCT) is increasingly used for major trauma, but its clinical benefits must be balanced against radiation exposure and resource utilization. This study aimed to explore the clinical benefits and radiation-related risks of WBCT across distinct trauma activation subgroups and to evaluate whether imaging strategies should be tailored to individual patient characteristics.
Methods:
We conducted this prospective randomized controlled trial at a Level I trauma center between March 2010 and January 2012. Patients meeting predefined trauma-team activation criteria were randomized to WBCT or conventional imaging. We evaluated diagnostic workflow, mortality, radiation exposure, complications, and delayed diagnoses. Patients were further classified into hemodynamically unstable, altered mental status, and mechanism-only activation subgroups.
Results:
A total of 151 patients were included in the final analysis: 73 in the WBCT group and 78 in the conventional group. WBCT required longer primary imaging time than conventional imaging (36 [IQR 30–47] vs. 31 [IQR 24–39] minutes, p = 0.002), but final decision-making time showed a non-significant trend toward reduction (96 vs. 128.5 minutes, p = 0.142). No statistically significant differences were observed in mortality, complications, or delayed diagnoses. Delayed diagnoses occurred in 18/73 patients (24.7%) in the WBCT group and 11/78 patients (14.1%) in the conventional group (p = 0.100). In subgroup analyses, WBCT was associated with lower radiation exposure among unstable patients (23.9 vs. 35.4 mSv, p = 0.02) but higher exposure among unconscious patients (24.9 vs. 18.0 mSv, p = 0.01). Because the final sample was substantially smaller than planned, the study was underpowered to detect differences in relatively infrequent clinical outcomes, particularly mortality and delayed diagnosis.
Discussion:
The potential value of WBCT may depend on the clinical scenario and the diagnostic pathway used. In our study, the differences in radiation exposure among trauma activation subgroups suggest that the trade-off between comprehensive imaging and radiation burden may not be uniform across patients. In addition, comprehensive imaging cannot replace repeated clinical assessment and tertiary evaluation for detecting subtle or delayed injuries.
Conclusion:
In this underpowered randomized cohort, WBCT did not demonstrate statistically significant improvements in survival or delayed diagnosis. Its potential benefits appeared to vary according to clinical presentation, suggesting that WBCT should be selectively tailored to individual patient characteristics and trauma-system context.