The Utility of Whole Body Computed Tomography in Trauma Activations and the Impact of Incidental Findings on Patient Management: A Review.

Traumatic injury remains a leading cause of death globally, necessitating rapid and accurate diagnostic tools in emergency settings. Whole-body computed tomography (WBCT) has emerged as an increasingly utilized component in trauma care due to its speed and diagnostic precision. This review summarizes current data on the impact of WBCT on trauma mortality and examines the frequency and clinical implications of incidental findings (IFs). PubMed/Medline was searched for randomized controlled trials (RCT) and meta-analyses in the context of WBCT's effect on trauma mortality as well as retrospective studies investigating the clinical impact of IF. Studies were excluded if they did not measure endpoints of mortality in relation to WBCT or the incidence and impact of IF in WBCT patients. Emergency Department (ED) length of stay (LOS) was significantly reduced by a mean of nine to 34 minutes in WBCT cohorts, with no significant change in hospital or intensive care unit LOS. Contrary to some previous analyses, survival benefit was not reproduced in an RCT in this context. IF were identified in 40-54.8% of WBCT trauma patients, with 29-69.2% of all findings detected on abdominal/pelvic scans. 5.8-31.3% of IF required urgent management. Follow-up on IF was often inadequate and approximately half of cases were omitted from discharge reports. WBCT potentially enhances trauma care through rapid diagnosis and reduced ED LOS. The lack of corroborating RCT evidence highlights the need for additional trials. Effective management of IF remains a critical area for improvement that may optimize patient outcomes. Institutions may benefit from developing guidelines to address the reporting and follow-up of IF in trauma patients.