Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival.

Background Immediate recognition of life-threatening conditions and
injuries is the key to trauma management. To date, the impact of
focused assessment with computed tomography in trauma (FACTT) has
not been formally assessed. We aimed to find out whether the
concept of using FACTT during primary trauma survey has a negative
or positive effect on survival. Methods In a retrospective,
multicentre study, we compared our time management and probability
of survival (Ps) in major trauma patients who received FACTT during
trauma resuscitation with the trauma registry of the German Trauma
Society (DGU). FACTT is defined as whole-body computed tomography
(WBCT) during primary trauma survey. We determined the probability
of survival according to the Trauma and Injury Severity Score
(TRISS), the Revised Injury Severity Classification score (RISC)
and the standardized mortality ratio (SMR). Results We analysed
4.817 patients from the DGU database from 2002 until 2004, 160
(3.3%) were from our trauma centre at the
Ludwig-Maximilians-University (LMU) and 4.657 (96.7%) from the DGU
group. 73.2% were male with a mean age of 42.5 years, a mean ISS of
29.8. 96.2% had suffered from blunt trauma. Time from admission to
FAST (focused assessment with sonography for trauma)(4.3 vs. 8.7
min), chest x-ray (8.1 vs. 16.0 min) and whole-body CT (20.7 vs.
36.6 min) was shorter at the LMU compared to the other trauma
centres (p < 0.001). SMR calculated by TRISS was 0.74 (CI95%
0.40-1.08) for the LMU (p = 0.24) and 0.92 (CI95% 0.84-1.01) for
the DGU group (p = 0.10). RISC methodology revealed a SMR of 0.69
(95%CI 0.47-0.92) for the LMU (p = 0.043) and 1.00 (95%CI
0.94-1.06) for the DGU group (p = 0.88). Conclusion Trauma
management incorporating FACTT enhances a rapid response to
life-threatening problems and enables a comprehensive assessment of
the severity of each relevant injury. Due to its speed and
accuracy, FACTT during primary trauma survey supports rapid
decision-making and may increase survival.