Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Alaniz, Leonardo; Muttalib, Omaer; Hoyos, Juan; Figueroa, Cesar; Barrios, Cristobal
• Is Part Of: American surgeon. Volume 87:Issue 10(2021)
• Page Start: 1600
• Page End: 1605
• Publication Date: 2021-10
• Subjects: pan-CT scan -- ISS inflation -- thoracic CT scan -- occult thoracic injury -- occult pneumothorax -- occult hemothorax -- occult rib fracture -- pulmonary contusion; Surgery -- Periodicals; Surgery -- United States -- Periodicals; 617.0973
• DOI: 10.1177/00031348211024973
• Languages: English
• ISSNs: 0003-1348

Abstract

Introduction: Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods: Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results: After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion: Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.