Whole-Body Computed Tomography (WBCT) for the initial assessment of trauma patients: a retrospective observational study

BACKGROUND: Clinicians assessing trauma patients are routinely faced with the critical question of when to pursue whole-body computed tomography (WBCT) and when to withhold it to limit unnecessary exposure and resource use. Despite its widespread integration into early trauma care, there remains uncertainty about the best approach for selecting patients for WBCT, particularly given the implications of its findings. We aimed to evaluate the clinical characteristics and outcomes of trauma patients with positive (pWBCT) versus negative (nWBCT) findings. METHODS: A retrospective study of adult trauma patients who underwent WBCT imaging in 2021 and 2022 was conducted. Patients were stratified into pWBCT; at least one acute traumatic injury identified on scan from head to pelvis or nWBCT; no acute traumatic injury detected on scan from head to pelvis. Clinical characteristics, mechanisms of injury, injury severity, Trauma activation level, and outcomes were analyzed. Multivariable logistic regression analysis was performed to identify independent predictors of pWBCT at presentation. RESULTS: A total of 2,555 patients were included (76.8% pWBCT and 23.2% nWBCT). pWBCT was associated with significantly higher rates of Level 1 trauma activations (20.5% vs 7.8%, p = 0.001), higher mean Injury Severity Score (ISS) (15.1 ± 9.9 vs 6.4 ± 4.1; p = 0.001), Shock Index (0.72 ± 0.24 vs. 0.67 ± 0.16; p = 0.001), and lower Trauma Score and Injury Severity Score (TRISS) (0.932 ± 0.15 vs 0.990 ± 0.02; p = 0.001). Patients with pWBCT required significantly higher rates of intubation, exploratory laparotomy, and massive blood transfusion. This group also had increased ICU admission, longer durations of mechanical ventilation, and higher mortality compared with patients with nWBCT (p < 0.001). Multivariable logistic regression analysis demonstrated that age (aOR 1.013; 95% CI 1.004-1.022; p = 0.003), male gender (aOR 0.687; 95% CI 0.475-0.995; p = 0.047), shock index (aOR 1.990; 95% CI 1.045-3.789; p = 0.036), lower GCS at ED (aOR 0.852; 95% CI 0.804-0.904; p = 0.001), traffic related incidents (aOR 1.464; 95% CI 1.065-2.012; p = 0.019), falls from height (aOR 2.545; 95% CI 1.750-3.701; p = 0.001), pedestrian crashes (aOR 1.620; 95% CI 1.013-2.588; p = 0.044), and a positive FAST (aOR 5.977; 95% CI 2.149-16.623; p = 0.001) were independent predictors of pWBCT. CONCLUSION: Patients with pWBCT form a high-risk population with greater injury severity, physiological instability, and intervention needs. The proportion of negative scans highlights potential overutilization. Identifying predictors of positive findings may refine imaging decisions, improve resource use, and support risk-stratified strategies to reduce unnecessary WBCT and its potential complications while avoiding missed injuries.