Is Computed Tomography Associated With Survival in Adult Trauma Patients in an Urban Lower-middle Income Setting?

Background

Trauma is defined as an injury caused by an external force to the body. Trauma is one of the major causes of death in the world and accounts for almost five million deaths per year. To quickly and accurately assess damage to internal organs and to be able to identify the potentially fatal injuries, various forms of imaging are used. Examples of such imaging are conventional x-ray scans, Focused Assessment by Sonography in Trauma (FAST), and Computed Tomography (CT). In high-income countries, it has become common to utilize CT as a routine investigation in trauma patients.

The use of whole body CT (WBCT) scans as opposed to selective scanning has been associated with survival benefits for trauma patients, even when the patients undergoing WBCT have more severe injuries than the control group. The studies that investigate this association have been done mostly in high-resource settings where the distance between resuscitation and imaging facilities are short, imaging facilities are more readily available, and the quality of the imaging may be better.

Trauma disproportionally affects low-resource settings. For example, road traffic injuries are responsible for more than 1,3 million deaths per year and of these approximately 90 percent occur in low- and middle-income countries. 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, it is unclear if the survival benefit associated with CT use in high-resource settings also can be observed in low-resource settings.

Aim