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Advance Trauma Life Support (ATLS) guidelines, used in the United States and more than 60 other countries, may be wrong when it comes to the timing of emergency CT scans, a new study suggests.

The guidelines say that for victims of severe trauma, after a quick once-over, the first priorities are resuscitation and, if bleeding is excessive, emergency surgery. Then can come diagnostic scans.

But a group of Japanese researchers looked at the fates of patients who had experienced blunt, nonpenetrating trauma, as might typically result from impact or physical attack. They found:

Whole-body CT performed before emergency bleeding control might be associated with improved survival, especially in patients at high risk of death and in hemodynamically unstable patients.

That’s the conclusion of an article about their research published online Tuesday in the open-access journal Critical Care.

The retrospective study covered records from 2004 through 2010 at two hospitals in Osaka, Japan: Osaka General Medical Center and Osaka University Graduate School of Medicine. The researchers looked for patients with blunt trauma who required emergency bleeding control and who were admitted directly from the scene of the incident. Both hospitals have CT scanners on the same floor as their trauma rooms and can do a full-body scan in 20 minutes, including patient transfer time.

After 28 days, survival rates were higher among the patients who had undergone full-body CT scans before surgery—but only for the patients with the most severe trauma or those with blood pressure so low they were hemodynamically unstable.

The authors speculated that in patients with bleeding in more than one body region, the scans helped physicians prioritize how and where to control the bleeding. And scans sometimes revealed unexpected sites of bleeding.

“Further clinical investigation is necessary,” the article says, “to clarify in which population with severe trauma CT will have the most significant effect on patient outcome.”

Related CME seminar (up to 20 AMA PRA Category 1 credits™): UCSF Practical Body Imaging

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