Diagnostic value of whole-body computed tomography in trauma patients

Objective: This study aimed to evaluate the diagnostic utility of whole-body computed tomography (WBCT) in trauma patients, to assess the appropriateness of imaging indications, and to investigate the impact of WBCT findings on clinical outcomes. Furthermore, the study sought to identify the rate of unnecessary WBCT applications and its influence on clinical decision-making. Methods: This retrospective descriptive study included 531 adult trauma patients who presented to the emergency department of a tertiary trauma center between January 2024 and July 2024 and underwent WBCT. Patients were assessed based on trauma mechanism (high vs. low-energy), presence of WBCT indication, radiologic findings (positive/negative), laboratory parameters (WBC, lactate), vital signs, and hospital outcomes (ICU admission, intubation, mortality). A multivariate logistic regression model was used to determine predictive factors for positive CT findings. Statistical significance was set at p<0.05. Results: Of the 531 patients, 296 (55.7%) had at least one positive radiological finding. Among patients exposed to high-energy trauma (n=288), 224 (77.8%) had positive CT results, compared to only 68 (28%) in the low-energy trauma group (p<0.001). In 192 patients (36.1%) WBCT was performed without indication, and 113 (58.9%) of these scans yielded negative results. The most common injuries were thoracic trauma (27.9%), head trauma (19.0%), intra-abdominal injuries (17.5%), and vertebral fractures (13.4%). "Occult injuries" not detected by physical examination were found in 122 patients, 47 of whom IX (38.5%) underwent a change in management based on CT findings. Age (OR: 1.030; p=0.001), lactate (OR: 2.939; p=0.040), and WBC count (OR: 1.080; p=0.021) were independently associated with positive CT results. ICU admission (24.3%) and in-hospital mortality (5.1%) rates were significantly higher in the positive WBCT group compared to negative ones (p<0.05). Conclusion: WBCT provides high diagnostic accuracy in the evaluation of trauma patients, particularly in those exposed to high-energy mechanisms, and plays a crucial role in clinical decision-making. However, the 36.1% rate of non-indicated scans— predominantly among younger patients with low-risk trauma—highlights concerns regarding unnecessary radiation exposure and contrast-related risks. Integrating clinical findings, trauma mechanism, and biomarkers such as lactate and WBC into selective CT decision algorithms could enhance diagnostic precision while minimizing risk and resource burden. Therefore, clinical protocols should be restructured in alignment with international guidelines such as ATLS, ACS-TQIP, and REACT-2, emphasizing a multiparametric and patient-centered approach to imaging in trauma care. Keywords: Trauma, Whole-body CT, WBCT, Polytrauma, Trauma Imaging, Trauma Lactate, Injury Distribution, Emergency Department Trauma Imaging.