• K Treskes, J C Sierink, EdwardsM J RMJRTrauma Unit, Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands., B J A Beuker, Van LieshoutE M MEMMTrauma Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands., J Hohmann, T P Saltzherr, M W Hollmann, S Van Dieren, J C Goslings, DijkgraafM G WMGWDepartment of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands., and REACT-2 study group.
• Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands.
• Br J Surg. 2021 Apr 5; 108 (3): 277285277-285.

BackgroundThe effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation.MethodsIn this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive.ResultsA total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference -5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9).ConclusionEconomically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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