Mortality With and Without Whole-Body CT in Severely Injured Children

Background: The choice of imaging modality-the use of whole-body computed tomography (WB-CT) versus a step-wise diagnostic procedure-in injured children is controversial. In this study we availed ourselves of data from the TR-DGU, the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie), to investigate whether the use of WB-CT improves the outcome.Methods: The TR-DGU data from the period 2012-2021 were evaluated. A three-stage analysis began with comparison of children with adults aged <= 50 years. As a second step, the observed and expected mortality in children with WB-CT was compared with the mortality in children without WB-CT. Finally, predictors of the use of WB-CT were identified so that a propensity score analysis of matched pairs could be performed.Results: A total of 65 092 patients were included, 4573 children (7%) and 60 519 adults (93%), with differences in accident type and injury pattern. Comparison of the ratio of observed to expected mortality revealed no difference between the two groups of children (standardized mortality ratio 0.97 with WB-CT, 0.95 without WB-CT). In adults, however, there was an advantage for the WB-CT group. The propensity score analysis of 1101 matched pairs showed identical mortality in the two groups (3.9% with WB-CT, 4.0% without WB-CT). Conclusion: The TR-DGU data show no benefit of WB-CT compared with step-wise diagnosis in the care of severely injured children. In view of the radiation exposure involved, with the danger of inducing malignancy, the benefits and risks of the use of WB-CT in children should be weighed up carefully in team discussions.

Automated summary

The use of whole-body computed tomography (WB-CT) in the diagnosis of injured children does not improve outcomes compared to a step-wise diagnostic procedure, according to data from the trauma registry of the German Society for Trauma Surgery. The risks and benefits of WB-CT in children, including the potential for radiation exposure and malignancy, should be carefully considered in team discussions.