How is Time to Computed Tomography Associated With Survival in Adult Trauma Patients in an Urban Lower-middle Income Setting?

Background

Trauma is major threat to population health worldwide, each year killing more people than malaria, tuberculosis, HIV/AIDS and maternal conditions combined. Almost five millions deaths occur annually as a result of injuries and of these approximately 90 percent occur in low- and middle-income countries (LMIC). An increase in road traffic deaths has been seen in many LMIC where motorization and urbanization has not been accompanied sufficiently by improved road safety strategies. In fact, in the age group 15-29 years, road traffic injuries are the leading cause of death worldwide. With these changing patterns in global health, trauma is now a condition needing greater priority to reduce avoidable mortality in young and middle-aged adults.

Early detection of potentially lethal or disabling injuries is crucial to reduce trauma mortality and morbidity. Imaging is at the core of such detection, and computed tomography (CT) is standard in trauma systems all over the world. Studies comparing whole body CT (WBCT) to selective CT imaging suggest that WBCT is associated with better outcomes and lower mortality rates. In a well structured environment, WBCT during trauma resuscitation was associated with significantly decreased mortality in haemodynamically stable as well as in haemodynamically unstable major trauma patients.

There is a strong push to perform CT as early as possible as part of the diagnostic workup. Immediate CT and rapid bleeding control without patient transfer, close distance of the CT scanner to the trauma room, as well as immediate WBCT after initial examination compared to selective CT imaging according to the Advanced Trauma Life Support (ATLS) guidelines was associated with improved probability of survival of severely injured patients in high income countries. However, no similar studies have been conducted in LMIC. There are concerns about such investigations delaying time-critical interventions. In low-resource settings the CT may be located far from the resuscitation and surgical resources, and the expertise needed to keep patients stable during the transfer to and from the CT may be limited. Therefore, whether time to CT is associated with survival remains unknown in low-middle income settings disproportionally affected by trauma.

Aim