Utilization of whole-body computed tomography in trauma: The role of trauma center level and ACS verification.

BACKGROUND

Whole-body computed tomography (WBCT) is frequently used in trauma, though its value in stable patients remains uncertain. We examined WBCT use after motor vehicle collision (MVC) and whether trauma center designation and American College of Surgeons Committee on Trauma (ACS-COT) verification were associated with imaging practices.

METHODS

Using 2018-2021 Trauma Quality Improvement Program (TQIP) data, we identified adults aged 18-65 with blunt MVC who were stable (systolic blood pressure ≥ 100 and Glasgow Coma Scale 15) and received a CT scan. WBCT was defined as head, chest, and abdomen CT within 2 h of admission; selective CT (SCT) covered fewer than all three regions. Temporal trends by state-designated trauma level and ACS-COT verification were assessed using Cuzick's nonparametric test, and multivariable logistic regression identified factors associated with WBCT use.

RESULTS

Among 288,264 stable MVC patients receiving CT, 78,796 (27.3%) underwent WBCT, and 209,468 (72.7%) SCT. WBCT utilization declined at ACS-verified (31.9 to 30.2%) and non-verified centers (22.0 to 18.4%), and at Level I (29.1 to 27.1%) and Level II (28.5 to 26.9%) facilities (all nptrend <0.001), with consistent declines across Injury Severity Score strata. After adjustment, ACS verification was associated with higher odds of WBCT (AOR 1.96, 95% CI 1.92-2.00), whereas non-profit or government ownership (AOR 0.55, 95% CI 0.54-0.57) was associated with lower odds.

CONCLUSIONS

In stable MVC patients, WBCT utilization declined from 2018 to 2021 across trauma levels and verification strata, while institutional characteristics remained strongly associated with WBCT.