Introduction: Single-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in\r\nthe early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an\r\nindicator of enhanced process quality of emergency care that may lead to improved survival regardless of the\r\nactual use of the method.\r\nMethods: This retrospective cohort study included consecutive patients with blunt trauma referred to a trauma\r\ncenter prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The\r\noverall mortality between the two periods was compared and stratified according to the availability and actual use\r\nof the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and\r\ninjury-related independent variables.\r\nResults: The study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of\r\nthe pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality\r\nwas 23.3, 14.8 and 7.9% (P < 0.001), respectively. By univariable logistic regression analysis, both the availability\r\n(odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95%\r\nCI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the\r\nGlasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained\r\nvariance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest\r\ninjury severity quartile.\r\nConclusions: In this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of\r\nthe pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently\r\nmoderate and needs further investigation with regard to the diagnostic yield and changes in management\r\ndecisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, ISRCTN35424832 and ISRCTN41462125)
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