Randomized study of Early Assessment by CT scanning in Trauma patients.

Background:

Trauma is a major source of death and morbidity, especially in people below the age of 50 years. In the Netherlands yearly 5,100 people die from accidents and 980,000 people visit an Emergency Department because of an injury. The use of CT scanning has gained wide acceptance in the evaluation of trauma patients and provides detailed information on location and severity of injuries. While rapid diagnosis and treatment are of paramount importance in trauma patients, CT scanning is frequently time consuming due to logistical (location of CT scanner elsewhere in the hospital) and technical issues. In one of two locations of the Northwest-Netherlands Trauma Center an innovative and unique infrastructural change has been made in which the CT is transported to the patient instead of the patient to the CT scanner. Such a new concept is (worldwide) currently only available in the Academic Medical Center in Amsterdam. Early shockroom CT scanning provides an all-inclusive multifocal diagnostic modality that can detect (potentially life-threatening injuries) in an earlier stage, so that therapy can be directed based on these findings.

Aim:

To assess the effect of a strategy involving early shockroom CT scanning with a standard diagnostic imaging strategy in trauma patients on both patient outcome and operations research.

Study design:

Prospective, randomized trial, comparing the two level-1 trauma centers VUmc and AMC.

Population:

All trauma patients that are transported to the AMC or VUmc shockroom according to the current prehospital triage system. Exclusion criteria are patients younger than 16 years of age, patients who die during transport, and patients (or close relatives) who decline transportation.

Intervention:

Patients are transported to either the VUmc or the AMC, based on randomization. Trauma care will remain the same for both institutions, with the only difference the location of the CT scanner.

Endpoints:

Patient outcome in both strategies will be compared using the number of days outside the hospital during the first year following the trauma as the primary outcome measure. Secondary outcomes include general health (EuroQol) at 6 and 12 months post trauma, mortality and morbidity, and various time intervals of the initial evaluation relevant to trauma care.

A trauma care strategy involving early shockroom CT scanning with a standard diagnostic imaging strategy in trauma patients has a positive effect on both patient outcome and operations research.

N/A

Patients are transported to either the VUmc or the AMC, based on randomization. Trauma care will remain the same for both institutions, with the only difference the location of the CT scanner.