Rationalizing whole-body computed tomography in trauma: A national audit on resource utilization and strategies to minimize radiation exposure

BACKGROUND: Major trauma is the sixth leading cause of death worldwide and the leading cause of death and disability in the population aged 5 years to 45 years. The assessment is typically guided by strict protocols to quickly identify life-threatening conditions before conducting a comprehensive evaluation of other injuries. Whole-body computed tomography (WBCT) is often indiscriminately used in trauma cases. AIM: To assess the effective use of WBCT in patients with trauma across radiology departments in State of Kuwait, evaluate the true incidence of critical injuries, and minimize unnecessary radiation exposure. METHODS: This multicenter, retrospective study across seven radiology departments included 1367 patients with trauma who underwent WBCT between 2022 and 2023, according to the American College of Radiology guidelines. Data on age, sex, injury mechanism, clinical indications, dose-length product, and WBCT findings were collected and analyzed using IBM SPSS version 25. RESULTS: Of 1367 referrals, 578 (42.3%) had no significant findings, while 789 (57.7%) showed positive trauma-related results. Among the positive findings, 530 patients (38.8%) had major injuries, including solid organ and vertebral column injuries. The most common causes of WBCT referrals were road traffic accidents (911 patients, 66.6%), falls from height (182 patients, 13%), falls of heavy objects (112 patients, 8%), head trauma (82 patients, 6%), buggy accidents (28 patients, 2%) and others. Negative WBCT findings had a mean effective dose of 19.98 ± 10.26 mSv. CONCLUSION: This national audit demonstrates that a substantial proportion of WBCT scans in patients with trauma are negative (42.3%), underscoring the need to rationalize imaging practices. The findings highlight the importance of evidence-based stewardship to enhance trauma care delivery in State of Kuwait.