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Never disrespect the randomized controlled trial. This is Healthcare Triage News.

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

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When my friends want to make fun of me, they often mock my love of comic books, video games, and randomized controlled trials. They've heard me utter the phrase countless times, especially when I'm ranting against something that everyone's got wrong, again. And, if you've watched almost any episode of Healthcare Triage, you've heard me say it. I love me some randomized controlled trials. Last week confirmed that once again. How? Whole body CTs after trauma. This is Healthcare Triage News.


To the research!

From the Lancet, Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial.

A number of observational studies have shown that total body CT scans are beneficial when working up a trauma victim. So, we do them. We know observational studies aren't what we need, but we do them.

Enter this randomized controlled trial from 4 hospitals in the Netherlands and Switzerland. Adults who had undergone trauma were randomized on a 1 to 1 basis to get either immediate total-body CT scans or a standard workup with conventional imaging and CT scanning when individually needed. Clearly, doctors weren't blinded to this, and neither were patients. The outcome of interest was in-hospital mortality.

Over nearly 3 years, almost 5,500 patients were assessed, and just over 1,400 were randomized. Almost 1,100 of them were included in the primary analysis. In-hospital mortality was 16% in the total-body CT group and 16% in the control group. So, no difference. There were also no significant differences in mortality in a subgroup of patients with polytrauma and a subgroup with traumatic brain injury. 3 serious adverse events occurred in the total-body CT group, and 1 in the standard group. Those patients all died.

This was an intention-to-treat analysis from a randomized controlled trial. It even had a power calculation. It was powered to see a difference of 5%. They found no difference at all, let alone a statistically significant one.

None of this means that some patients don't need a total-body CT. This is just about doing one as a knee-jerk reaction to all trauma patients. And, I'm fine hearing a debate on these findings, but they contradict prior, weaker studies. Total-body CT involves a lot of radiation, and it's not without harm. It also costs money.

Debate is fine. In fact, it's necessary. Don't sweep this under the rug, and don't ignore it. Don't pretend it's just one more study equal to the others. It's a randomized controlled trial. We ignore these things too often. We need to stop.

So, don't make fun of my comic book collection, and never disrespect the randomized controlled trial.


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