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Item does not contain fulltext BACKGROUND: Immediate total body computed tomography (CT) scanning has become important in the early diagnostic phase of trauma care because of its high diagnostic accuracy. However, literature provides limited evidence whether immediate total body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total body CT scanning in trauma patients. DESIGN: The REACT-2 trial is an international, multicenter randomized clinical trial. METHODS: All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. The intervention group will receive a contrast-enhanced total body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness. CONCLUSION: The REACT-2 trial is the first multicenter randomized clinical trial that will provide evidence on the value of immediate total body CT scanning during the primary survey of severely injured trauma patients.

Teun Saltzherr onderzocht de verbetering van de primaire diagnostiek en behandeling van ernstige traumapatiënten. Hij concludeert dat een moderne traumakamer waarin de CT-scanner is geïntegreerd, voordelen oplevert voor logistiek en workflow bij een gemiddelde traumapatiënt, maar geen voor- of nadelen heeft wat betreft klinische uitkomsten en kosteneffectiviteit. Wel lijkt er een positief effect op de klinische uitkomsten bij ernstig gewonde traumapatiënten. Saltzherr ziet ruimte voor verdere optimalisatie van bestaande procedures voor beeldvorming en opvang. Het AMC behaalt in vergelijking met wat in de literatuur wordt genoemd goede resultaten.

Item does not contain fulltext 01 juni 2012

Trauma care puts considerable burden on the global healthcare system. Traumatic spinal injuries are relatively common and have the lowest functional outcomes and the lowest return-to-work rates after injury of all major traumas. Given these societal impacts, understanding the incidence, characteristics and healthcare demands of spinal injuries – and how these parameters develop over time – is crucial. The aim of this thesis was to determine the incidence of spinal injuries in the Netherlands, to evaluate the effectiveness of spinal immobilization procedures, and to document the diagnostic workup of spinal injuries in children. In terms of incidence, between 1997 and 2012, the number of patients with a spinal fracture in the Netherlands more than doubled, while the hospitalization rate and number of spinal cord injuries remained stable. Regarding the effectiveness of spinal immobilization, experts disagree about the need for immobilization for all patients with suspected spinal cord injuries, and high-level scientific evidence to support or reject immobilization is lacking. Although spinal immobilization is widely used to prevent spinal cord injury, it cannot be explained historically, and the potential dangers of spinal immobilization have been widely reported. Studies completed as part of this thesis suggest that many patients are immobilized unnecessarily. In children, while the guidelines for cervical spine imaging are clear, the use of computed tomography has increased significantly since its introduction, especially in the emergency department. This is concerning given the potential increase in lifetime cancer risk in children due to the radiation used in this type of imaging.

This thesis focuses on the consequences of immediate total-body CT (iTBCT) scanning in comparison to the standard work-up and the indication for iTBCT scanning after severe trauma in a large randomized controlled trial. Next to the effect on clinical outcomes, the effect on clinically relevant time intervals, radiation exposure and health economics effects are evaluated. These effects are also evaluated specifically for patients in need for emergency bleeding control interventions. The criteria for iTBCT are reconsidered in order to select the more severely injured patients and reduce the chance on unnecessary radiation exposure for the less severely injured patients.