@phdthesis{Jodkowski2013,
  author    = {Jakub Jodkowski},
  title     = {Primary Pan-CT is associated with improved clinical course and outcome in polytrauma patients},
  journal    = {Ganzk{\"o}rper-CT ist assoziiert mit verbessertem klinischen Verlauf und Ergebnis bei polytraumatisierten Patienten},
  url       = {https://nbn-resolving.org/urn:nbn:de:gbv:9-001506-6},
  year      = {2013},
  abstract  = {The early clinical management of patients with polytrauma remains challenging. Clinical examination is unreliable in identifying the presence and severity of injuries, and diagnostic imaging plays a central role in the evaluation of the injury pattern. In the last decade, whole body multi slice computed tomography (Pan-CT) performed immediately after admission gained recognition in Europe and United States. Its utility and value, given the lack of accuracy data and concerns about unnecessary exposure to radiation, is undefined. The primary objective of this retrospective cohort study was to compare survival of multiple trauma (polytrauma) patients (Injury Severity Score [ISS] ≥ 16) prior to (1999 - 2002) and after (2002 - 2004) the introduction of a Pan-CT-based trauma resuscitation algorithm at a maximum care university medical centre. Secondary objectives were to compare the complication rates and duration of intensive care treatment. The study included 123 patients (mean age 34.6 years [SD 16.8], mean ISS 26.7 [SD 8.7]) in the control and 104 (mean age 39.8 years [SD 20.0], mean ISS 28.6 [SD 10.5]) patients in the intervention period. Die Baseline criteria were well balanced amongst both cohorts except for age (34.6 versus 39.8 years, p = 0.034). Both cohorts had a similar predicted probability of survival using the TRISS method (77.5 versus 77.6\%, p = 0.979). Raw mortality decreased markedly but not statistically significantly in Pan-CT cohort (17.9 versus 11.5\%, risk ratio (RR) 0.65, 95\% confidence interval (CI) 0.34 - 1.24). However, after adjustment for injury severity, by mortality odds ratio of 0.40 (95\% CI 0.17 – 0.95, p = 0.038) Pan-CT patients were 2.5 times more likely to survive. The mean difference in the duration of ICU treatment (5.1, 95\% CI 1.2 – 9.0 days), days on respirator (5.3, 95\% CI 2.0 - 8.6), and number of complications (0.4, 95\% CI 0.2 – 0.8) was statistically significant and in favour of the Pan-CT-period.},
  language  = {en}
}