Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 9 , ISSUE 1 ( January-April, 2020 ) > List of Articles

Original Article

Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study

Ana M Del Valle, Michael Parra, Monica Guzman-Rodriguez, Juan P Herrera-Escobar, Carlos García, Alberto F Garcia, Hernan E Munevar, Constanza Navarro, Alejandra de las Salas, Laura Ibarra, Alfonso Holguin

Keywords : Computed tomography, Delay, Organ-selective CT scan, Radiation exposure, Single pass

Citation Information : Del Valle AM, Parra M, Guzman-Rodriguez M, Herrera-Escobar JP, García C, Garcia AF, Munevar HE, Navarro C, de las Salas A, Ibarra L, Holguin A. Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study. Panam J Trauma Crit Care Emerg Surg 2020; 9 (1):26-31.

DOI: 10.5005/jp-journals-10030-1262

License: CC BY-NC 4.0

Published Online: 25-04-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to organ-selective CT (OSCT), and it does not inflict further delays in diagnosis. Materials and methods: We retrospectively review all trauma patients in whom CT scans were performed on arrival at a level I trauma center, from January 2016 to December 2017. Results: A total of 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma, and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma, and head injuries were the most common (71.9%). The OSCT group required subsequent follow-up studies to rule out other injuries, which in turn did not occur in the WBCT group (47.2% vs 0%, p < 0.001). The total radiation exposure dose was higher in the OSCT group [22 mSv (IQR 6–31) vs 15.1 mSv (IQR 9.9–24.8) p < 0.001]. The median CT scan-to-diagnosis time was lower in the WBCT group [22 minutes (14–32) vs 32 minutes (21–65); p < 0.001]. Conclusion: The OSCT has the potential of missing potentially life-threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient's overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in diagnosis. Level of evidence: V, therapeutic.

  1. Gondek S, Schroeder ME, Sarani B. Assessment and resuscitation in trauma management. Surg Clin North Am [Internet] 2017;97(5): 985–998. DOI: 10.1016/j.suc.2017.06.001.
  2. ATLS Subcommittee. American college of Surgeons’ committee on trauma, international ATLS working group. Advanced trauma life support (ATLS®). J Trauma Acute Care Surg 2013;74(5):1363–1366.
  3. Leidner B, Adiels M, Aspelin P, et al. Standardized CT examination of the multitraumatized patient. Eur Radiol 1998;8(9):1630–1638. DOI: 10.1007/s003300050601.
  4. Kim Y-J, Kim J-S, Cho S-H, et al. Characteristics of computed tomography in hemodynamically unstable blunt trauma patients. Medicine (Baltimore) 2017;96(49):e9168. DOI: 10.1097/MD.0000000000009168.
  5. Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: Review of the current literature. Turkish J Emerg Med 2018;18(4):142–147. DOI: 10.1016/j.tjem.2018.09.003.
  6. Weninger P, Mauritz W, Fridrich P, et al. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. J Trauma - Inj Infect Crit Care 2007;62(3):584–591. DOI: 10.1097/
  7. Wurmb TE, Quaisser C, Balling H, et al. Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma. Emerg Med J 2011;28(4): 300–304. DOI: 10.1136/emj.2009.082164.
  8. Tsutsumi Y, Fukuma S, Tsuchiya A, et al. Whole-body computed tomography during initial management and mortality among adult severe blunt trauma patients: a nationwide cohort study. World J Surg 2018;42(12):3936–3946. DOI: 10.1007/s00268-018-4732-5.
  9. Chidambaram S, Goh EL, Khan MA. A meta-analysis of the efficacy of whole-body computed tomography imaging in the management of trauma and injury. Injury 2017;48(8):1784–1793. DOI: 10.1016/j.injury.2017.06.003.
  10. Alagic Z, Eriksson A, Drageryd E, et al. Whole body CT versus selective radiological imaging strategy in trauma: an evidence-based clinical review. Br J Radiol [Internet] 2017;89(1061):647–652. DOI: 10.1136/emermed-2016–206167.Available from:
  11. Dreizin D, Munera F. Multidetector CT for penetrating torso trauma: state of the art. Radiology 2015;277(2):338–355. DOI: 10.1148/radiol.2015142282.
  12. Christner JA, Kofler JM, McCollough CH. Estimating effective dose for ct using dose-length product compared with using organ doses: Consequences of adopting international commission on radiological protection publication 103 or dual-energy scanning. Am J Roentgenol 2010;194(4):881–889. DOI: 10.2214/AJR.09.3462.
  13. Mccollough CH, Schueler BA. Educational treatise: calculation of effective dose. Med Phys 2000;27(5):828–837. DOI: 10.1118/1.598948.
  14. Hutter M, Woltmann A, Hierholzer C, et al. Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scand J Trauma Resusc Emerg Med [Internet] 2011;19(1):73. DOI: 10.1186/1757-7241-19-73Available from:
  15. Kinoshita T, Yamakawa K, Matsuda H, et al. The survival benefit of a novel trauma workflow that includes immediate whole-body computed tomography, surgery, and interventional radiology, all in one trauma resuscitation room: a retrospective historical control study. Ann Surg 2019;269(2):370–376. DOI: 10.1097/SLA.0000000000002527.
  16. Huber-Wagner S, Biberthaler P, Häberle S, et al. Whole-body CT in haemodynamically unstable severely injured patients - A retrospective, multicentre study. PLoS ONE 2013;8(7):e68880. DOI: 10.1371/journal.pone.0068880.
  17. Jiang L, Ma Y, Jiang S, et al. Comparison of whole-body Computed tomography vs selective radiological imaging on outcomes in major trauma patients: A meta-analysis. Scand J Trauma Resusc Emerg Med 2014;22(54):1–11. DOI: 10.1186/s13049-014-0054-2.
  18. Smith C, Woolrich-Burt L, Wellings R, et al. Major trauma CT scanning: The experience of a regional trauma centre in the UK. Emerg Med L 2011;28(5):378–382. DOI: 10.1136/emj.2009.076414.
  19. Hickethier T, Mammadov K, Baeßler B, et al. Whole-body computed tomography in trauma patients: optimization of the patient scanning position significantly shortens examination time while maintaining diagnostic image quality. Ther Clin Risk Manag 2018;14:849–859. DOI: 10.2147/TCRM.S162074.
  20. Boscak AR, Shanmuganathan K, Mirvis SE, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 2013;268(1):79–88. DOI: 10.1148/radiol.13121370.
  21. Hakim W, Kamanahalli R, Dick E, et al. Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection. Br J Radiol 2016;89(1063):20160160. DOI: 10.1259/bjr.20160160.
  22. Godt JC, Eken T, Schulz A, et al. Triple-split-bolus versus single-bolus CT in abdominal trauma patients: a comparative study. Acta Radiol 2018;59(9):1038–1044. DOI: 10.1177/0284185117752522.
  23. Iacobellis F, Ierardi AM, Mazzei MA, et al. Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications. Br J Radiol 2016;89(1061):20150952. DOI: 10.1259/bjr.20150952.
  24. Nguyen D, Platon A, Shanmuganathan K, et al. Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma. AJR Am J Roentgenol 2009;192(1):3–10. DOI: 10.2214/AJR.07.3702.
  25. Van Vugt R, Kool DR, Deunk J, et al. Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients. J Trauma Acute Care Surg 2012;72(3):553–559. DOI: 10.1097/TA.0b013e31822dd93b.
  26. Baghdanian AH, Baghdanian AA, Armetta A, et al. Effect of an institutional triaging algorith on the use of multidetector CT for patients with blunt abdominopelvic trauma over an 8-year period. Radiology 2017;282(1):84–91. DOI: 10.1148/radiol.2016152021.
  27. Huber-Wagner S, Lefering R, Qvick LM, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet [Internet] 2009;373(9673):1455–1461. DOI: 10.1016/S0140-6736(09)60232-4.
  28. Wada D, Nakamori Y, Yamakawa K, et al. Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma. Crit Care 2013;17(4):R178. DOI: 10.1186/cc12861.
  29. Ordoñez CA, Herrera-Escobar JP, Parra MW, et al. Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients. J Trauma Acute Care Surg 2016;80(4):597–603. DOI: 10.1097/TA.0000000000000975.
  30. Sierink JC, Treskes K, Edwards MJ, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet [Internet] 2016;388(10045):673–683. DOI: 10.1016/S0140-6736(16)30932-1.
  31. Brenner D, Hall E. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357(22):2277–2284. DOI: 10.1056/NEJMra072149.
  32. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380(9840):499–505. DOI: 10.1016/S0140-6736(12)60815-0.
  33. Abe T, Aoki M, Deshpande G, et al. Is whole-body CT associated with reduced in-hospital mortality in children with trauma? A nationwide study. Pediatr Crit Care Med 2019;20(6):e245–e250. DOI: 10.1097/PCC.0000000000001898.
  34. Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004;232(3): 735–738. DOI: 10.1148/radiol.2323031095.
  35. Brink M, de Lange F, Oostveen LJ, et al. Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: Higher image quality, lower radiation dose. Radiology 2008;249(2):661–670. DOI: 10.1148/radiol.2492080169.
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