REACT-2

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

Sierink JC, Treskes K, Edwards MJ, et al. Lancet (London, England) 2016 · PMID 27371185 · doi:10.1016/s0140-6736(16)30932-1

Question

Does immediate whole-body CT reduce in-hospital mortality compared with conventional imaging and selective CT in severe trauma?

Design

International multicentre RCT in trauma centres in the Netherlands and Switzerland.

Patients

Adult trauma patients with compromised vital signs, life-threatening injuries or severe injury suspected.

Intervention

Immediate total-body CT

Comparison

Conventional radiographs and FAST followed by selective CT

Primary outcome

In-hospital mortality

Key result

Immediate total-body CT did not significantly reduce in-hospital mortality compared with a standard imaging approach.

Limitations

Many patients turned out to be less severely injured than expected, and the control arm often still received CT, diluting any difference.

Impact on practice

Whole-body CT remains standard in UK major trauma centres for adults with major trauma per NICE, but REACT-2 shows it is a diagnostic tool rather than a survival intervention in itself.