Can Leukocyte Count Predict the Presence of Post-traumatic Lesions on the Wbct in Clinically Stable Severe Trauma Patients ? A Retrospective Study

Can Leukocyte Count Predict the Presence of Post-traumatic Lesions on the Wbct in Clinically Stable Severe Trauma Patients ? 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A Retrospective Study Laura Grau-Mercier, Pauline Boclaud, Florian Ajavon, Fabien Coisy, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6706216/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Nov, 2025 Read the published version in BMC Emergency Medicine → Version 1 posted 11 You are reading this latest preprint version Abstract Background : Severe grade C trauma patients usually benefit from whole-body computed tomography (WBCT) to search for traumatic lesions, in the absence of clinical signs. The systematic use of WBCT in clinically stable patients with severe trauma remains controversial. Objective : The aim of this study was to evaluate the diagnostic value of the blood leukocyte count in predicting the existence of traumatic lesions on WBCT in grade C severe trauma patients. Methods : This was an observational, retrospective, monocentric study of severe grade C trauma patients who underwent WBCT and leukocyte blood testing in the emergency department. The diagnosis of post-traumatic injury on WBCT was based on the detection of cranial, thoracic, abdominal, large-vessel, spinal and pelvic injuries. The primary endpoint was blood leukocyte count. Results : Eight hundred and six patients were included, 301 (37.3%) had severe traumatic lesions and 505 (62.7%) did not. The leukocyte count was significantly higher in patients with traumatic lesions than in those without (15.8 G.L -1 ± 5.1 vs. 11.0 G.L -1 ± 4.1; p<0.01). The AUC of the ROC curve derived from this sample was 0.79 [0.75; 0.82], corresponding to a good diagnostic value. Using the optimal threshold of 13.5 G L -1 , sensitivity was 66% [60%; 71%], specificity 80% [77%; 84%], PPV 67% [61%; 72%] and NPV 80% [76%; 83%]. Conclusion : The leukocyte count on venous blood assay was significantly higher in severe grade C trauma patients with severe traumatic lesions on the WBCT, but doesn't seem to be a sufficient criterion to avoid WBCT. Its analysis coupled with other biological or clinical criteria could be studied. Trial registration : This study was approved by the local institutional review board (no. 24.02.01). leukocytes severe trauma emergency care biomarker WBCT Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Traumatology is a major public health problem, as it is considered the leading cause of death in patients under the age of 45, and accounts for a large proportion of emergency department activity ( 1 ). Although there is currently no consensual definition, any patient who has suffered a violent trauma should be considered severe, regardless of apparent lesions ( 1 ). Their management is based on a “trauma system” organized territorially by each healthcare system. In France, the development of such networks began in 2008 with the RESUVAL “SOS-Trauma” network (“Reseau des Urgences de la Vallée du Rhône”), the RENAU Trauma System (“Réseau Nord Alpin des Urgences”) and, more recently, the Trauma Base network ( 2 , 3 ). The initial management of these patients and their referral to the appropriate care pathway is based on a triage scale, including clinical signs and circumstantial elements : grade A for unstable patient, grade B for patient with clinical signs of severity and grade C ( 3 ). Patients with no clinical signs of severity are considered severely traumatized grade C if the vital signs are stable and there are high-kinetic criteria or a high-risk medical history ( 3 ). In emergency departments, the management of severe trauma patients focuses primarily on the detection and treatment of fatal injuries. Diagnosis and management of additional injuries are the focus of secondary care. This approach is summarized in the Advanced Trauma Life Support protocol ( 4 ), which emphasizes a detailed physical examination and basic radiological imaging, but the evolution of computed tomography technology has led to a shift in daily practice towards whole-body imaging. Whole body computed tomography (WBCT) used for early diagnosis of traumatic lesions and prevention of clinically invisible lesions, has been shown in several studies to reduce mortality in these patients by between 13 and 25% ( 5 , 6 ). WBCT detects traumatic lesions with good sensitivity in patients with an ISS score above 15 ( 7 , 8 ). WBCT can identify clinically silent lesions in around 15% of clinically stable patients categorized as severe trauma based on age, terrain or accident kinetics (grade C) ( 9 ). However, performing a WBCT exposes patients to high doses of ionizing radiation: around 20 mSv ( 8 ), leading to a risk of radiation-induced cancer ( 10 ). Thus, the systematic use of WBCT in clinically stable patients with severe trauma (grade C) remains a matter of debate, with no established consensus regarding its indications. ( 11 , 12 , 13 ). More precise selection criteria for grade C severe trauma patients to benefit from WBCT are therefore needed. The use of biological markers as a tool of triage has so far been little studied, apart from lactates, which have shown contradictory results ( 14 , 15 ). When traumatic organ injury occurs, the body reacts by activating its inflammatory response: a systemic inflammatory response syndrome (SIRS) is triggered ( 16 , 17 ). As a result, certain biological markers could be elevated in the bloodstream. Studying the relevance of routinely measured biological markers in estimating the probability of post-traumatic injury could help better targeting WBCT indications in clinically stable severe trauma patients. The aim of this study was to observe leukocytosis in a population of clinically stable severe trauma patients. The main objective of this study was to evaluate the diagnostic value of blood leukocyte count in predicting the presence of severe post-traumatic lesions on WBCT in clinically stable patients classified as severe trauma according to high-kinetic criteria or a high-risk medical history (grade C). Methods Study design This is a retrospective, observational, monocentric study conducted at the University hospital of Nîmes, France. . It was approved by the local institutional review board (no. 24.02.01).The study was based on a database containing all the WBCTs of severe trauma patients treated between January 2020 and January 2022. Patient data were collected from their medical records. Patients were informed of the computerized processing of data concerning them, which were collected during this research, also specifying their rights of access, opposition, effacement, rectification to these data, as well as limitation of processing. After receiving this informed information by mail, participants could object to the use of their data, in which case they were not included. The process has been approved by the University Hospital of Nîmes institutional review board. A data anonymization procedure was subsequently effected: patients were identified by a unique 7-character identification number. Participants of the study The study population consisted of patients categorized as severely traumatized (1). Adults patients with a violent trauma likely to present one or more life-threatening traumatic injuries and who had undergone a WBCT ( CT head, CT chest, and CT abdomen/pelvis scans, with contrast injection) were considered for inclusion in our study. Only patients classified Grade C according to the grading scale for on scene evaluation and triage of trauma victims used in France (3) were included. Grade C is defined as normal vital signs and at least one criteria (3) : High-kinetic: fall from more than 6 m; ejected/projected/ blasted; death in the same vehicle Penetrating injury to head/neck/trunk Open fracture femur/humerus Fracture of more than 2 segments of long bone Insufficient analgesia despite morphine Treatment with anticoagulant agent > 65 years old Severe comorbidity : congenital heart disease, chronic respiratory insufficiency, haematological and neuromuscular diseases Exclusion criteria were : Age under 18 Pregnancy Grade A (3) : systolic blood pressure (SBP) 1500 mL and/or vasopressor, SpO2 <94% despite O2 therapy , Glasgow score scale (GSC) 90 mmHg after resuscitation, SpO2> 94% with O2 therapy ,GCS 9-13 , spinal cord injury with paraplegia or tetraplegia, positive FAST, severe pelvic injury, severe limb injury with hemorrhage, ischemia or the need for a tourniquet Absence of leucocyte assay during emergency care Outcomes The primary outcome of this study was the leukocyte count in G.L -1 on the venous blood test routinely performed on admission to the emergency department. The secondary outcomes of this study were Shock Index (systolic blood pressure/heart rate) on admission to the emergency department and biological parameters on the initial venous blood test : hemoglobin (g.dL -1 ), prothrombin time (%), activated partial thromboplastin time (s),platelet count (G.L -1 ), creatinine (µmol.L -1 ), blood calcium (mmol.L -1 ), hepatic cytolysis characterized by the presence of elevated transaminases > 3 times normal, and CPK (mmol.L -1 ). All outcomes were extracted from computerized patient records. Study design Patients were divided into 2 groups for analysis of primary and secondary endpoints, based on the WBCT results : patients with severe post-traumatic lesions on WBCT reading and patients without severe post-traumatic lesions on WBCT reading. We considered an injury to be severe if it is life- or function-threatening, or requires surgery or hospitalization. A WBCT was considered positive if it detected one of the following lesions: - Cranial lesion: subdural hematoma, extradural hematoma, intra-parenchymal hemorrhage, subarachnoid hemorrhage, skull vault fracture. - Thoracic injury: > 3 rib fractures, hemothorax, pneumothorax, pulmonary contusion, diaphragmatic rupture, sternal fracture. - Abdominal injury: splenic injury, hepatic injury, renal injury, pancreatic injury, colonic injury. - Large-vessel injury - Retroperitoneal hematoma - Pelvic fracture - Spinal fracture All WBCT had been routinely interpreted by an experienced radiologist during emergency care. Statistical analysis Quantitative data were expressed as means with standard deviations or median with 25th and 75th percentiles according to distribution. Qualitative variables were expressed as frequency with percentages. For the primary endpoint, the serum leukocyte count was compared between the two groups using the Student t test or Wilcoxon‐Mann‐Whitney test according to the distribution. A logistic regression model was performed to assess the performance of leukocyte count to predict the presence of a post-traumatic lesion on the WBCT using a receiver operating characteristic (ROC) curve with an estimate of its area under the curve (AUC) and its 95% confidence interval (CI). An optimal threshold was sought with Youden index (sensitivity + specificity - 1) maximization. For the secondary endpoints, the association between the presence of post-traumatic s lesions and quantitative variables (reflecting other biological factors) was assessed in the same way: using a logistic regression model, an ROC curve with estimated AUC and 95% CI. All statistical analyses were conducted using SAS (9.4; SAS Inc, Cary, NC, USA). All p values were two tailed and a p value less than 0.05 was considered significant. Results Population Eight hundred and six patients were included in the emergency department of Nîmes university hospital. The patient flow chart is presented in Figure 1. The characteristics of the study population and their initial clinical features are summarized in Table 1. Table 1 in additional content shows the locations of traumatic lesions highlighted at the WBCT. Primary outcome A mean leukocyte count of 15.8 G.L -1 ± 5.1 was found in severe grade C trauma patients with severe post-traumatic lesions, and a mean count of 11.0 G.L -1 ± 4.1 in patients without severe post-traumatic lesions, with a p-value < 0.01. (figure 2). The mean leukocyte count was 16.1 G.L -1 ± 5.3 in the subgroup of patients with cranial lesion ( including subdural hematoma, extradural hematoma, intra-parenchymal hemorrhage and subarachnoid hemorrhage) , which was significantly higher than in the rest of the population with a mean of 12.4 G.L -1 ± (4.9) (p< 0.01). The area under the curve of ROC curve of leucocyte count to predict the presence of a severe post-traumatic lesion on the WBCT was 0.79 [0.75; 0.82] (figure 3); with an optimal threshold value of 13.5 G.L -1 (Youden index: 0.46). At this threshold, sensitivity was 66% [60; 71], specificity 80% [77; 84], PPV 67% [61; 72], NPV 80% [76; 83]. Secondary outcomes Table 2 shows the secondary endpoints for the two patient groups. ROC curves of secondary outcomes significantly different between the two groups to predict the presence of a severe post-traumatic lesion on the WBCT are presented in figure 4. Discussion This retrospective study aimed to investigate the diagnostic performance of leukocyte count in predicting the presence of severe traumatic lesions on WBCT in clinically stable severe trauma patients. In this study population, the leukocyte count was significantly higher in patients with traumatic lesions than in those without (15.8 G.L -1 ± 5.1 vs. 11.0 G.L -1 ± 4.1; p < 0.01). The AUC of the ROC curve derived from this sample was 0.79 [0.75; 0.82], corresponding to a good diagnostic value ( 18 ). The Youden index identified a threshold of 13.5 G L -1 for which the diagnostic performance of the leukocyte count appeared to be maximal, with a sensitivity of 66% [60%; 71%], a specificity of 80% [77%; 84%], a PPV of 67% [61%; 72%] and an NPV of 80% [76%; 83%]. The leukocyte assay therefore appears to predict the absence of traumatic lesions in severe grade C trauma patients, with a good negative predictive value. However, this threshold value should be interpreted with caution, as the standard deviations in leukocytosis values overlapped in both groups. The mean leukocyte count in our study population was 12.8 G.L -1 , similar to levels found in studies of severe trauma patients ( 19 ). Elevation of leucocyte had already been studied in blunt trauma, and had moderate discriminatory capability for serious injury ( 20 ). The association between the presence of traumatic lesions on the WBCT and CPK levels, also had an interesting diagnostic performance, with an AUC of 0.72 [0.68–0.78] for CPK . The use of biological markers in the triage of trauma patients is still relatively little used. A secondary analysis carried out on isolated cerebral injuries showed a significant difference in leukocyte count in patients with traumatic cerebral injuries. In the case of cerebral trauma, the S100B protein assay for the detection of intracranial hemorrhage has been validated by numerous data in the literature ( 21 ). The copeptin assay has also been studied to determine the severity and prognosis of severe trauma patients. High copeptin levels were associated with increased mortality, severe injury and bleeding in these patients( 22 ). Coagulation score systems taking into account platelet count, PT and fibrinogen have also demonstrated their ability to predict mortality in patients with severe trauma ( 23 ). This study as few limitations. The main limitation of this study is its retrospective nature, which does not allow us to ensure the reproducibility of our results. It was also a monocentric study. However, the characteristics of the study population are similar to those found in other large-scale studies on severe trauma ( 19 ). One piece of data that was not mentioned in the medical records and that would be interesting to collect in a prospective study is the time between the trauma and the blood sample, in the hypothesis that an early assay could underestimate leukocytosis. Experimentally, this delay would be 1 hour, with an effect lasting 6 hours, on the assumption that the rise in leukocytes after a trauma is linked to the secretion of adrenaline and cortisol ( 24 ). The assay of these two hormones could also be of interest for a better understanding of the physiopathological mechanisms involved. Another unreported finding was the type of leukocytes found, with neutrophils often the most represented in the leukocyte demarginalization pool ( 19 ). In addition, a centralized review of WBCTs could have limited assessment bias, but would not be representative of the actual management of severe trauma in emergency units. Our primary endpoint, leukocyte count, is a marker that can be increased in non-traumatic conditions, especially during inflammatory or infectious processes ( 25 ). The presence of confounding factors such as sepsis concomitant with trauma may therefore alter the specificity of this assay, diagnostic sensitivity however remains preserved. The diagnostic value of leukocytes in determining the presence of traumatic lesions on WBCT in grade C trauma patients should be confirmed with a prospective study. It may also be appropriate to study the diagnostic value of a composite criterion including several biological markers, or of a multimodal algorithm combining clinical and biological markers. Imaging modalities could also evolve in cases where these markers predict a low risk of traumatic lesions on CT. The use of ultra-low-dose CT in peripheral trauma ( 26 ) and chest trauma ( 27 ) seem to be relevant, but its use for whole-body imaging in multi-trauma patients seems to have limitations ( 28 ). Conclusion The leukocyte count on venous blood assay was significantly higher in severe grade C trauma patients with severe traumatic lesions on the WBCT, but doesn't seem to be a sufficient criterion to avoid WBCT. Its analysis coupled with other biological or clinical criteria could be studied. Declarations Ethics approval and consent to participate : This study approved by the University Hospital of Nîmes institutional review board (no. 24.02.01). Patients were informed of the computerized processing of data concerning them, which were collected during this research, also specifying their rights of access, opposition, effacement, rectification to these data, as well as limitation of processing. After receiving this informed information by mail, participants could object to the use of their data, in which case they were not included. The process has been approved by the University Hospital of Nîmes institutional review board. Consent for publication : Not applicable. Availability of data and materials : All data generated or analysed during this study are included in this published article and its supplementary information files. The datasets used or analysed during the current study are also available from the corresponding author on reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : The authors did not receive any funding for this research. Authors' contributions : Conception and Study design: LG, PB, JF Literature Review: LG, PB Data acquisition: PB, JF Data Analysis and Interpretation: LG, PB Drafting of the manuscript: LG Critical revision: FA, FC, RGG, JF, XB Acknowledgements : Not applicable. References Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg. 2007;31(7):1507– 1511 Bouzat P, Ageron FX, Brun J, Levrat A, Berthet M, Rancurel E, et al. A regional trauma system to optimize the prehospital triage of trauma patients. Crit Care 2015;19:111. Bouzat P; GITE Network. Standardizing categorization of major trauma patients in France: A position paper from the GITE Network. Anaesth Crit Care Pain Med. 2024 Apr;43(2):101345. Galvagno SM Jr, Nahmias JT, Young DA. Advanced Trauma Life Support ® Update 2019: Management and Applications for Adults and Special Populations. Anesthesiol Clin. 2019 Mar;37(1):13-32. 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Refining the criteria for immediate total-body CT after severe trauma. Eur Radiol. 2020 May;30(5) Santucci CA, Purcell TB, Mejia C. Leukocytosis as a predictor of severe injury in blunt trauma. West J Emerg Med. 2008 May;9(2):81-5. Oris C, Kahouadji S, Durif J, Bouvier D, Sapin V. S100B, Actor and Biomarker of Mild Traumatic Brain Injury. Int J Mol Sci. 2023 Apr 1;24(7) Sarkarinejad, A., Paydar, S., Khosrojerdi, A. et al. Copeptin: a novel prognostic biomarker in trauma: a review article. J Health Popul Nutr 42, 128 (2023). Lee DH, Lee BK, Jeung KW, Park JS, Lim YD, Jung YH, Lee SM, Cho YS. Performance of 5 disseminated intravascular coagulation score systems in predicting mortality in patients with severe trauma. Medicine (Baltimore). 2018 Aug;97 Parks KR, Davis JM. Epinephrine, cortisol, endotoxin, nutrition, and the neutrophil. Surg Infect (Larchmt). 2012 Oct;13(5):300-6. Urrechaga E. Reviewing the value of leukocytes cell population data (CPD) in the management of sepsis. Ann Transl Med. 2020 Aug;8(15) Addala TE, Greffier J, Hamard A, Snene F, Bobbia X, Bastide S, Belaouni A, de Forges H, Larbi A, de la Coussaye JE, Beregi JP, Claret PG, Frandon J. Early results of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg. 2022 Aug;12(8) Kim SJ, Bista AB, Min YG, Kim EY, Park KJ, Kang DK, Sun JS. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma. Medicine (Baltimore). 2017 Jan;96(2):e5888. Alagic Z, Eriksson A, Drageryd E, Motamed SR, Wick MC. A new low-dose multi-phase trauma CT protocol and its impact on diagnostic assessment and radiation dose in multi-trauma patients. Emerg Radiol. 2017 Oct;24(5):509-518. Tables Table 1- Population characteristics and clinical features. WBCT = whole-body computing imaging , SAP = systolic arterial pressure. Severe lesion on WBCT No severe lesion on WBCT Total P-value Whole population 301 505 806 Female 84 (28%) 147 (29%) 231 (29%) 0.72 Age (years) 42 (18 ; 92 ) 31 (18 ; 95 ) 35 (18 ; 95 ) <0.01 SAP (mmHg) 128 (±20) 132 (±18) 130 (±19) <0.01 Heart rate ( min-1 ) 85 (±16) 86 (±16) 85 (±16) 0.92 SpO2 (%) 97 (±2) 98 (±2) 98 (±2) <0.01 Glasgow score scale 15 (±0.3) 15 (±0.1) 15 (±0.2) <0.01 Trauma mechanism - Traffic accident 256 (76%) 457(91%) 683 (85%) - Fall from more than 6 meters 68 (23%) 42 (8%) (14%) - Stab wound 5 (2%) 4 (1%) 9 (1%) Age over 75 years old 21 (7%) 14 (3%) 35 (4%) <0.01 Anticoagulant treatment 8 (3%) 5 (1%) 13 (2%) 0.08 Double platelet antiaggregation 3 (1%) 3 (0.6%) 6 (0.7%) 0.68 Severe comorbidity * 9 (3%) 9 (2%) 18 (2%) 0.26 Discharge from hospital after emergency care 74 (25%) 448 (89%) 522 (65%) Admission unit - Medicine or surgery unit 145 (48%) 50 (10%) 195 (24%) - Intensive care unit 82 (28%) 5 (1%) 87 (11%) 30-days survival 301 (100%) 504 (100%) 805 (100%) 30-days readmission 3 (1%) 10 (2%) 13 (2%) 0.39 * congenital heart disease, chronic respiratory insufficiency, haematological or neuromuscular diseases Table 2 – Secondary outcomes. 3N = three times normal . Severe lesion on WBCT No severe lesion on WBCT Total p-value Shock index 0.7 (±0.2) 0.7 (±0.2) 0.7 (±0.2) 0.10 Hemoglobin (g.dL -1 ) 13.9 (±1.8) 14.3 (±1.5) 14.1 (±1.6) <0.01 Prothrombin time (%) 90.8 (±12.1) 93.7 (±8.1) 92.6 (±9.9) <0.01 Activated partial thromboplastin time (s) 0.9 (±0.1) 1.0 (±0.1) 0.9 (±0.1) <0.01 Platelets count (G.L -1 ) 246.1 (±59.9) 254.3 (±67.1) 251.2 (±64.6) 0.06 Creatinine (µmol.L -1 ) 83.4 (±37.2) 75.9 (±16.7) 78.7 (±26.5) 3N 18 (6.5%) 8 (1.7%) 26 (3.5%) <0.01 CPK (mmol.L -1 ) 402.2 [254 ;664] 205 [119 ;334] 260 [144;490] <0.01 Calcemia (mmol.L -1 ) 2.2 (±0.1) 2.2 (±0.1) 2.2 (±0.1) 0.27 Additional Declarations No competing interests reported. Supplementary Files Additionalcontenttable1.docx Additional content legend Table 1- Locations of severe traumatic lesions highlighted at the WBCT. WBCT= whole-body computing imaging. Cite Share Download PDF Status: Published Journal Publication published 12 Nov, 2025 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 24 Jun, 2025 Reviews received at journal 22 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviews received at journal 15 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 27 May, 2025 Editor invited by journal 27 May, 2025 Submission checks completed at journal 23 May, 2025 First submitted to journal 23 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Grau-Mercier","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYBACPgSTsQFEyoGIAw/waGFD12IM1pJAnBYISARrxKuF/YzZhx8M2+TM2w83Pq74dS99ftjhh0Bb7OR0G3Bo4ckxntnDcNtY5kxis+HZvuLcjbfTDIBako3NDuByWI4xAw/D7cQZEoxtko09CbkbZyeAtBxI3IZLC/8bY8Y/DLfrgVrafwK1pBvOTv+AX4tEjjEz0JYECaAtjA0/EhLkpXMI2CLxrJhZxuC24QyexGbJxoYEww3SOQUHEgxw+4WfP3kz45uK2/IS7Mcffmz4kyAvPzt984cPFXZyuLRAgAGUZmwDsg8gixAGfxgY5BuIVj0KRsEoGAUjBAAAtCZc2NFndlkAAAAASUVORK5CYII=","orcid":"","institution":"Montpellier University, Nîmes University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Laura","middleName":"","lastName":"Grau-Mercier","suffix":""},{"id":463190240,"identity":"a3a58475-2ffd-4f69-86bc-9ca17cf40a15","order_by":1,"name":"Pauline Boclaud","email":"","orcid":"","institution":"Montpellier University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pauline","middleName":"","lastName":"Boclaud","suffix":""},{"id":463190241,"identity":"3af6a94d-b659-4b60-87a6-d8b4deb25d94","order_by":2,"name":"Florian Ajavon","email":"","orcid":"","institution":"Montpellier University, Nîmes University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Florian","middleName":"","lastName":"Ajavon","suffix":""},{"id":463190242,"identity":"b751acad-6149-4f48-a849-8a0cd1978eec","order_by":3,"name":"Fabien Coisy","email":"","orcid":"","institution":"Montpellier University, Nîmes University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fabien","middleName":"","lastName":"Coisy","suffix":""},{"id":463190243,"identity":"be023e67-6b6a-41a7-b370-eed1e93e5338","order_by":4,"name":"Romain Genre Grandpierre","email":"","orcid":"","institution":"Nîmes University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Romain","middleName":"Genre","lastName":"Grandpierre","suffix":""},{"id":463190244,"identity":"a66b5158-e7dd-4bb3-864a-afe086c964e0","order_by":5,"name":"Julien Frandon","email":"","orcid":"","institution":"Montpellier University, Nîmes University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Julien","middleName":"","lastName":"Frandon","suffix":""},{"id":463190245,"identity":"bef9dcaa-6a6c-4ac7-adac-8a06407af9c9","order_by":6,"name":"Xavier Bobbia","email":"","orcid":"","institution":"Montpellier University, Montpellier University Hospital Université de Montpellier","correspondingAuthor":false,"prefix":"","firstName":"Xavier","middleName":"","lastName":"Bobbia","suffix":""}],"badges":[],"createdAt":"2025-05-20 09:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6706216/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6706216/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-025-01384-9","type":"published","date":"2025-11-12T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83768320,"identity":"81e22405-8bd1-4fee-8137-98a6fa030bc3","added_by":"auto","created_at":"2025-06-02 11:41:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":474052,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart. \u003cem\u003eWBCT= whole-body computing imaging.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/81dc1b827aaaea279e41f403.jpg"},{"id":83768321,"identity":"464d682e-183c-46f2-8cba-5d706806d41d","added_by":"auto","created_at":"2025-06-02 11:41:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":204092,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of leukocyte count results according to the presence of severe post-traumatic lesions objectified on the WBCT. \u003cem\u003eWBCT= whole-body computing imaging\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/fcc75d33b8aacc8103c0324a.jpg"},{"id":83768460,"identity":"716d339f-39d2-409d-abde-737fffb8ad3d","added_by":"auto","created_at":"2025-06-02 11:49:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":217248,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of leucocyte count to predict the presence of a severe post-traumatic lesion on the WBCT.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/892679c5e834de0a5e6d7605.jpg"},{"id":83768323,"identity":"d031fda3-5216-4946-bf20-5af21d3d95fb","added_by":"auto","created_at":"2025-06-02 11:41:37","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":506814,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves to predict the presence of a severe post-traumatic lesion on the WBCT of : A) Hemoglobin ; B) Prothrombin time (PT) ; C)Activated partial thromboplastin time (APTT) ; D) Creatinine ; E) CPK.\u003cem\u003e AUC = area under the curve, CI = Confidence interval.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/7ba6afd0bfb9c88ed4d9e525.jpg"},{"id":96104949,"identity":"1319420a-ed63-498a-adac-111f47e93df4","added_by":"auto","created_at":"2025-11-17 16:03:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2091946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/a4e0ba42-3b99-4f2c-a063-f39f7e2581ef.pdf"},{"id":83768317,"identity":"6a1ea97e-3279-45d0-94e8-76c44ee76002","added_by":"auto","created_at":"2025-06-02 11:41:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22969,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional content legend\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1- Locations of severe traumatic lesions highlighted at the WBCT. \u003cem\u003eWBCT= whole-body computing imaging.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Additionalcontenttable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6706216/v1/3637d951c551095297638154.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCan Leukocyte Count Predict the Presence of Post-traumatic Lesions on the Wbct in Clinically Stable Severe Trauma Patients ? A Retrospective Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eTraumatology is a major public health problem, as it is considered the leading cause of death in patients under the age of 45, and accounts for a large proportion of emergency department activity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although there is currently no consensual definition, any patient who has suffered a violent trauma should be considered severe, regardless of apparent lesions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Their management is based on a \u0026ldquo;trauma system\u0026rdquo; organized territorially by each healthcare system. In France, the development of such networks began in 2008 with the RESUVAL \u0026ldquo;SOS-Trauma\u0026rdquo; network (\u0026ldquo;Reseau des Urgences de la Vall\u0026eacute;e du Rh\u0026ocirc;ne\u0026rdquo;), the RENAU Trauma System (\u0026ldquo;R\u0026eacute;seau Nord Alpin des Urgences\u0026rdquo;) and, more recently, the Trauma Base network (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The initial management of these patients and their referral to the appropriate care pathway is based on a triage scale, including clinical signs and circumstantial elements : grade A for unstable patient, grade B for patient with clinical signs of severity and grade C (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Patients with no clinical signs of severity are considered severely traumatized grade C if the vital signs are stable and there are high-kinetic criteria or a high-risk medical history (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn emergency departments, the management of severe trauma patients focuses primarily on the detection and treatment of fatal injuries. Diagnosis and management of additional injuries are the focus of secondary care. This approach is summarized in the Advanced Trauma Life Support protocol (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), which emphasizes a detailed physical examination and basic radiological imaging, but the evolution of computed tomography technology has led to a shift in daily practice towards whole-body imaging.\u003c/p\u003e \u003cp\u003eWhole body computed tomography (WBCT) used for early diagnosis of traumatic lesions and prevention of clinically invisible lesions, has been shown in several studies to reduce mortality in these patients by between 13 and 25% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). WBCT detects traumatic lesions with good sensitivity in patients with an ISS score above 15 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). WBCT can identify clinically silent lesions in around 15% of clinically stable patients categorized as severe trauma based on age, terrain or accident kinetics (grade C) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, performing a WBCT exposes patients to high doses of ionizing radiation: around 20 mSv (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), leading to a risk of radiation-induced cancer (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Thus, the systematic use of WBCT in clinically stable patients with severe trauma (grade C) remains a matter of debate, with no established consensus regarding its indications. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMore precise selection criteria for grade C severe trauma patients to benefit from WBCT are therefore needed. The use of biological markers as a tool of triage has so far been little studied, apart from lactates, which have shown contradictory results (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen traumatic organ injury occurs, the body reacts by activating its inflammatory response: a systemic inflammatory response syndrome (SIRS) is triggered (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). As a result, certain biological markers could be elevated in the bloodstream. Studying the relevance of routinely measured biological markers in estimating the probability of post-traumatic injury could help better targeting WBCT indications in clinically stable severe trauma patients.\u003c/p\u003e \u003cp\u003eThe aim of this study was to observe leukocytosis in a population of clinically stable severe trauma patients. The main objective of this study was to evaluate the diagnostic value of blood leukocyte count in predicting the presence of severe post-traumatic lesions on WBCT in clinically stable patients classified as severe trauma according to high-kinetic criteria or a high-risk medical history (grade C).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective, observational, monocentric study conducted at the University hospital of N\u0026icirc;mes, France. . It was approved by the local institutional review board (no. 24.02.01).The study was based on a database containing all the WBCTs of severe trauma patients treated between January 2020 and January 2022. Patient data were collected from their medical records. Patients were informed of the computerized processing of data concerning them, which were collected during this research, also specifying their rights of access, opposition, effacement, rectification to these data, as well as limitation of processing. After receiving this informed information by mail, participants could object to the use of their data, in which case they were not included. The process has been approved by the University Hospital of N\u0026icirc;mes institutional review board. A data anonymization procedure was subsequently effected: patients were identified by a unique 7-character identification number.\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003eParticipants of the study\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of patients categorized as severely traumatized (1). Adults patients with a violent trauma likely to present one or more life-threatening traumatic injuries and who had undergone a WBCT ( CT head, CT chest, and CT abdomen/pelvis scans, with contrast injection) were considered for inclusion in our study. \u003c/p\u003e\n\n\u003cp\u003eOnly patients classified Grade C according to the grading scale for on scene evaluation and triage of trauma victims used in France (3) were included. Grade C is defined as normal vital signs and at least one criteria (3) :\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eHigh-kinetic: fall from more than 6 m; ejected/projected/ blasted; death in the same vehicle \u003c/li\u003e\n\u003cli\u003ePenetrating injury to head/neck/trunk \u003c/li\u003e\n\u003cli\u003eOpen fracture femur/humerus\u003c/li\u003e\n\u003cli\u003eFracture of more than 2 segments of long bone\u003c/li\u003e\n\u003cli\u003eInsufficient analgesia despite morphine \u003c/li\u003e\n\u003cli\u003eTreatment with anticoagulant agent \u003c/li\u003e\n\u003cli\u003e\u0026gt; 65 years old\u003c/li\u003e\n\u003cli\u003eSevere comorbidity : congenital heart disease, chronic respiratory insufficiency, haematological and neuromuscular diseases\u003c/li\u003e\n\u003c/ul\u003e\n\n\u003cp\u003eExclusion criteria were : \u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eAge under 18\u003c/li\u003e\n\u003cli\u003ePregnancy\u003c/li\u003e\n\u003cli\u003eGrade A (3) : systolic blood pressure (SBP) \u0026lt;90mmHg despite fluid loading \u0026gt; 1500 mL and/or vasopressor, SpO2 \u0026lt;94% despite O2 therapy , Glasgow score scale (GSC) \u0026lt;8\u003c/li\u003e\n\u003cli\u003eGrade B : SBP \u0026gt;90 mmHg after resuscitation, SpO2\u0026gt; 94% with O2 therapy ,GCS 9-13 , spinal cord injury with paraplegia or tetraplegia, positive FAST, severe pelvic injury, severe limb injury with hemorrhage, ischemia or the need for a tourniquet\u003c/li\u003e\n\u003cli\u003eAbsence of leucocyte assay during emergency care\u003c/li\u003e\n\u003c/ul\u003e\n\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome of this study was the leukocyte count in G.L\u003csup\u003e-1 \u003c/sup\u003eon the venous blood test routinely performed on admission to the emergency department.\u003c/p\u003e\n\n\u003cp\u003eThe secondary outcomes of this study were Shock Index (systolic blood pressure/heart rate) on admission to the emergency department and biological parameters on the initial venous blood test : hemoglobin (g.dL\u003csup\u003e-1\u003c/sup\u003e), prothrombin time (%), activated partial thromboplastin time (s),platelet count (G.L\u003csup\u003e-1\u003c/sup\u003e), creatinine (\u0026micro;mol.L\u003csup\u003e-1\u003c/sup\u003e), blood calcium (mmol.L\u003csup\u003e-1\u003c/sup\u003e), hepatic cytolysis characterized by the presence of elevated transaminases \u0026gt; 3 times normal, and CPK (mmol.L\u003csup\u003e-1\u003c/sup\u003e).\u003c/p\u003e\n\n\u003cp\u003eAll outcomes were extracted from computerized patient records.\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients were divided into 2 groups for analysis of primary and secondary endpoints, based on the WBCT results : patients with severe post-traumatic lesions on WBCT reading and patients without severe post-traumatic lesions on WBCT reading. We considered an injury to be severe if it is life- or function-threatening, or requires surgery or hospitalization.\u003c/p\u003e\n\n\u003cp\u003eA WBCT was considered positive if it detected one of the following lesions:\u003c/p\u003e\n\u003cp\u003e- Cranial lesion: subdural hematoma, extradural hematoma, intra-parenchymal hemorrhage, subarachnoid hemorrhage, skull vault fracture.\u003c/p\u003e\n\u003cp\u003e- Thoracic injury: \u0026gt; 3 rib fractures, hemothorax, pneumothorax, pulmonary contusion, diaphragmatic rupture, sternal fracture.\u003c/p\u003e\n\u003cp\u003e- Abdominal injury: splenic injury, hepatic injury, renal injury, pancreatic injury, colonic injury.\u003c/p\u003e\n\u003cp\u003e- Large-vessel injury\u003c/p\u003e\n\u003cp\u003e- Retroperitoneal hematoma\u003c/p\u003e\n\u003cp\u003e- Pelvic fracture\u003c/p\u003e\n\u003cp\u003e- Spinal fracture\u003c/p\u003e\n\n\u003cp\u003eAll WBCT had been routinely interpreted by an experienced radiologist during emergency care.\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were expressed as means with standard deviations or median with 25th and 75th percentiles according to distribution. Qualitative variables were expressed as frequency with percentages.\u003c/p\u003e\n\u003cp\u003eFor the primary endpoint, the serum leukocyte count was compared between the two groups using the Student t test or Wilcoxon‐Mann‐Whitney test according to the distribution. A logistic regression model was performed to assess the performance of leukocyte count to predict the presence of a post-traumatic lesion on the WBCT using a receiver operating characteristic (ROC) curve with an estimate of its area under the curve (AUC) and its 95% confidence interval (CI). An optimal threshold was sought with Youden index (sensitivity + specificity - 1) maximization.\u003c/p\u003e\n\u003cp\u003eFor the secondary endpoints, the association between the presence of post-traumatic s lesions and quantitative variables (reflecting other biological factors) was assessed in the same way: using a logistic regression model, an ROC curve with estimated AUC and 95% CI.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using SAS (9.4; SAS Inc, Cary, NC, USA). All p values were two tailed and a p value less than 0.05 was considered significant. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003ePopulation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEight hundred and six patients were included in the emergency department of N\u0026icirc;mes university hospital. The patient flow chart is presented in Figure 1.\u003c/p\u003e\n\u003cp\u003eThe characteristics of the study population and their initial clinical features are summarized in Table 1. Table 1 in additional content shows the locations of traumatic lesions highlighted at the WBCT.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePrimary outcome\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA mean leukocyte count of 15.8 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn; 5.1\u0026nbsp;was found in severe grade C trauma patients with severe post-traumatic lesions, and a mean count of 11.0 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn; 4.1 \u0026nbsp;in patients without severe post-traumatic lesions, with a p-value \u0026lt; 0.01. (figure 2). The mean leukocyte count was 16.1 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn;\u0026nbsp;5.3 in \u0026nbsp; the subgroup of patients with cranial lesion ( including subdural hematoma, extradural hematoma, intra-parenchymal hemorrhage and subarachnoid hemorrhage) , which was significantly higher than in the rest of the population with a mean of \u0026nbsp;12.4 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn;\u0026nbsp;(4.9) (p\u0026lt; 0.01). The area under the curve of ROC curve of leucocyte count to predict the presence of a severe post-traumatic lesion on the WBCT was 0.79 \u0026nbsp; [0.75; 0.82] (figure 3); with an optimal threshold value of 13.5 G.L\u003csup\u003e-1\u003c/sup\u003e (Youden index: 0.46). \u0026nbsp;At this threshold, sensitivity was 66%\u0026nbsp;[60;\u0026nbsp;71],\u0026nbsp;specificity 80% [77; 84], PPV 67% [61; 72], NPV 80% [76; 83].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSecondary outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the secondary endpoints for the \u0026nbsp;two patient groups. ROC curves of secondary outcomes significantly different between the two groups to predict the presence of a severe post-traumatic lesion on the WBCT are presented in figure 4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis retrospective study aimed to investigate the diagnostic performance of leukocyte count in predicting the presence of severe traumatic lesions on WBCT in clinically stable severe trauma patients.\u003c/p\u003e \u003cp\u003eIn this study population, the leukocyte count was significantly higher in patients with traumatic lesions than in those without (15.8 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn; 5.1 vs. 11.0 G.L\u003csup\u003e-1\u003c/sup\u003e \u0026plusmn; 4.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The AUC of the ROC curve derived from this sample was 0.79 [0.75; 0.82], corresponding to a good diagnostic value (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The Youden index identified a threshold of 13.5 G L\u003csup\u003e-1\u003c/sup\u003e for which the diagnostic performance of the leukocyte count appeared to be maximal, with a sensitivity of 66% [60%; 71%], a specificity of 80% [77%; 84%], a PPV of 67% [61%; 72%] and an NPV of 80% [76%; 83%]. The leukocyte assay therefore appears to predict the absence of traumatic lesions in severe grade C trauma patients, with a good negative predictive value. However, this threshold value should be interpreted with caution, as the standard deviations in leukocytosis values overlapped in both groups.\u003c/p\u003e \u003cp\u003eThe mean leukocyte count in our study population was 12.8 G.L\u003csup\u003e-1\u003c/sup\u003e, similar to levels found in studies of severe trauma patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Elevation of leucocyte had already been studied in blunt trauma, and had moderate discriminatory capability for serious injury (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The association between the presence of traumatic lesions on the WBCT and CPK levels, also had an interesting diagnostic performance, with an AUC of 0.72 [0.68\u0026ndash;0.78] for CPK .\u003c/p\u003e \u003cp\u003eThe use of biological markers in the triage of trauma patients is still relatively little used. A secondary analysis carried out on isolated cerebral injuries showed a significant difference in leukocyte count in patients with traumatic cerebral injuries. In the case of cerebral trauma, the S100B protein assay for the detection of intracranial hemorrhage has been validated by numerous data in the literature (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The copeptin assay has also been studied to determine the severity and prognosis of severe trauma patients. High copeptin levels were associated with increased mortality, severe injury and bleeding in these patients(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Coagulation score systems taking into account platelet count, PT and fibrinogen have also demonstrated their ability to predict mortality in patients with severe trauma (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study as few limitations. The main limitation of this study is its retrospective nature, which does not allow us to ensure the reproducibility of our results. It was also a monocentric study. However, the characteristics of the study population are similar to those found in other large-scale studies on severe trauma (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). One piece of data that was not mentioned in the medical records and that would be interesting to collect in a prospective study is the time between the trauma and the blood sample, in the hypothesis that an early assay could underestimate leukocytosis. Experimentally, this delay would be 1 hour, with an effect lasting 6 hours, on the assumption that the rise in leukocytes after a trauma is linked to the secretion of adrenaline and cortisol (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The assay of these two hormones could also be of interest for a better understanding of the physiopathological mechanisms involved. Another unreported finding was the type of leukocytes found, with neutrophils often the most represented in the leukocyte demarginalization pool (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In addition, a centralized review of WBCTs could have limited assessment bias, but would not be representative of the actual management of severe trauma in emergency units.\u003c/p\u003e \u003cp\u003eOur primary endpoint, leukocyte count, is a marker that can be increased in non-traumatic conditions, especially during inflammatory or infectious processes (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The presence of confounding factors such as sepsis concomitant with trauma may therefore alter the specificity of this assay, diagnostic sensitivity however remains preserved.\u003c/p\u003e \u003cp\u003eThe diagnostic value of leukocytes in determining the presence of traumatic lesions on WBCT in grade C trauma patients should be confirmed with a prospective study. It may also be appropriate to study the diagnostic value of a composite criterion including several biological markers, or of a multimodal algorithm combining clinical and biological markers.\u003c/p\u003e \u003cp\u003eImaging modalities could also evolve in cases where these markers predict a low risk of traumatic lesions on CT. The use of ultra-low-dose CT in peripheral trauma (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and chest trauma (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) seem to be relevant, but its use for whole-body imaging in multi-trauma patients seems to have limitations (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe leukocyte count on venous blood assay was significantly higher in severe grade C trauma patients with severe traumatic lesions on the WBCT, but doesn't seem to be a sufficient criterion to avoid WBCT. Its analysis coupled with other biological or clinical criteria could be studied.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eEthics approval and consent to participate :\u0026nbsp;\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study approved by the University Hospital of N\u0026icirc;mes institutional review board (no. 24.02.01). Patients were informed of the computerized processing of data concerning them, which were collected during this research, also specifying their rights of access, opposition, effacement, rectification to these data, as well as limitation of processing. After receiving this informed information by mail, participants could object to the use of their data, in which case they were not included. The process has been approved by the University Hospital of N\u0026icirc;mes institutional review board.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\n \u003ch2\u003eConsent for publication :\u0026nbsp;\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAvailability of data and materials :\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files. The datasets used or analysed during the current study are also available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\n \u003ch2\u003eCompeting interests :\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\n \u003ch2\u003eFunding :\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors did not receive any funding for this research.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\n \u003ch2\u003eAuthors\u0026apos; contributions :\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eConception and Study design: LG, PB, JF\u003c/p\u003e\n\u003cp\u003eLiterature Review: LG, PB\u003c/p\u003e\n\u003cp\u003eData acquisition: PB, JF\u003c/p\u003e\n\u003cp\u003eData Analysis and Interpretation: LG, PB\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: LG\u003c/p\u003e\n\u003cp\u003eCritical revision: FA, FC, RGG, JF, XB\u0026nbsp;\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\n \u003ch2\u003eAcknowledgements :\u0026nbsp;\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg. 2007;31(7):1507\u0026ndash; 1511\u003c/li\u003e\n \u003cli\u003eBouzat P, Ageron FX, Brun J, Levrat A, Berthet M, Rancurel E, et al. A regional trauma system to optimize the prehospital triage of trauma patients. Crit Care 2015;19:111.\u003c/li\u003e\n \u003cli\u003eBouzat P; GITE Network. Standardizing categorization of major trauma patients in France: A position paper from the GITE Network. Anaesth Crit Care Pain Med. 2024 Apr;43(2):101345.\u003c/li\u003e\n \u003cli\u003eGalvagno SM Jr, Nahmias JT, Young DA. Advanced Trauma Life Support\u003csup\u003e\u0026reg;\u003c/sup\u003e Update 2019: Management and Applications for Adults and Special Populations. Anesthesiol Clin. 2019 Mar;37(1):13-32.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSurendran, A., Mori, A., Varma, D. K., \u0026amp; Gruen, R. L. (2014). Systematic review of the\u0026nbsp;benefits\u0026nbsp;and\u0026nbsp;harms\u0026nbsp;of\u0026nbsp;whole-body\u0026nbsp;computed\u0026nbsp;tomography\u0026nbsp;in\u0026nbsp;the\u0026nbsp;early management of multitrauma patients. Journal of Trauma and Acute Care Surgery, 76(4), 1122\u0026ndash;1130.\u003c/li\u003e\n \u003cli\u003eHuber-Wagner S, Lefering R, Qvick LM, K\u0026ouml;rner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009 Apr 25;373(9673):1455-61.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLinn S. The injury severity score--importance and uses. Ann Epidemiol. 1995 Nov;5(6):440-6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYoong S, Kothari R, Brooks A. Assessment of sensitivity of whole body CT for major trauma. Eur J Trauma Emerg Surg. 2019 Jun;45(3):489-492.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBabaud J, Ridereau-Zins C, Bouhours G, Lebigot J, Le Gall R, Bertrais S, Roy PM, Aub\u0026eacute; C. Benefit of the Vittel criteria to determine the need for whole body scanning in a severe trauma patient. Diagn Interv Imaging. 2012 May;93(5):371-9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBeatty L, Furey E, Daniels C, Berman A, Tallon JM. Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience. CJEM. 2015 Nov;17(6):617-23.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWierzchołowski W, Walecki J, Latos T. Rationality of using whole-body computed tomography in trauma patients. Pol J Radiol. 2020 Mar 9;85:e132-e136.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMulas\u0026nbsp;V,\u0026nbsp;Catalano\u0026nbsp;L,\u0026nbsp;Geatti\u0026nbsp;V,\u0026nbsp;Alinari\u0026nbsp;B,\u0026nbsp;Ragusa\u0026nbsp;F,\u0026nbsp;Golfieri\u0026nbsp;R,\u0026nbsp;Orlandi\u0026nbsp;PE,\u0026nbsp;Imbriani\u0026nbsp;M. Major trauma with only dynamic criteria: is the routine use of whole-body CT as a first level examination justified? Radiol Med. 2022 Jan;127(1):65-71\u003c/li\u003e\n \u003cli\u003eRaux M, Vivien B, Tourtier JP, Langeron O. Severity assessment in trauma patient. Ann Fr Anesth Reanim. 2013 Jul-Aug;32(7-8):472-6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBaxter J, Cranfield KR, Clark G, Harris T, Bloom B, Gray AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg. 2016 Sep;81(3):555-66.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Baron BJ, Nguyen A, Stefanov D, Shetty A, Zehtabchi S. Clinical value of triage lactate in risk stratifying trauma patients using interval likelihood ratios. Am J Emerg Med. 2018 May;36(5):784-788.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZhang Q, Raoof M, Chen Y, Sumi Y, Sursal T, Junger W, et al. Circulating mitochondrial DAMPs \u0026nbsp; \u0026nbsp;cause inflammatory responses to injury. Nature. 2010; 464(7285):104\u0026ndash;7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLord JM, Midwinter MJ, Chen YF, Belli A, Brohi K, Kovacs EJ, Koenderman L, Kubes P, Lilford RJ. The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet. 2014 Oct 18;384(9952):1455-65. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. sept 1988;44(3):837‐45.\u003c/li\u003e\n \u003cli\u003eTreskes\u0026nbsp;K,\u0026nbsp;Saltzherr\u0026nbsp;TP,\u0026nbsp;Edwards\u0026nbsp;MJR,\u0026nbsp;Beuker\u0026nbsp;BJA,\u0026nbsp;Van\u0026nbsp;Lieshout\u0026nbsp;EMM,\u0026nbsp;Hohmann J, Luitse JSK, Beenen LFM, Hollmann MW, Dijkgraaf MGW, Goslings JC; REACT-2 study group. Refining the criteria for immediate total-body CT after severe trauma. Eur Radiol. 2020 May;30(5)\u003c/li\u003e\n \u003cli\u003eSantucci CA, Purcell TB, Mejia C. Leukocytosis as a predictor of severe injury in blunt trauma. West J Emerg Med. 2008 May;9(2):81-5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOris C, Kahouadji S, Durif J, Bouvier D, Sapin V. S100B, Actor and Biomarker of Mild Traumatic Brain Injury. Int J Mol Sci. 2023 Apr 1;24(7)\u003c/li\u003e\n \u003cli\u003eSarkarinejad, A., Paydar, S., Khosrojerdi, A. \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eCopeptin: a novel prognostic biomarker in trauma: a review article. \u003cem\u003eJ Health Popul Nutr\u0026nbsp;\u003c/em\u003e42, 128 (2023).\u003c/li\u003e\n \u003cli\u003eLee DH, Lee BK, Jeung KW, Park JS, Lim YD, Jung YH, Lee SM, Cho YS. Performance of 5 disseminated intravascular coagulation score systems in predicting mortality in patients with severe trauma. Medicine (Baltimore). 2018 Aug;97\u003c/li\u003e\n \u003cli\u003eParks KR, Davis JM. Epinephrine, cortisol, endotoxin, nutrition, and the neutrophil. Surg Infect (Larchmt). 2012 Oct;13(5):300-6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUrrechaga\u0026nbsp;E.\u0026nbsp;Reviewing\u0026nbsp;the\u0026nbsp;value\u0026nbsp;of\u0026nbsp;leukocytes\u0026nbsp;cell\u0026nbsp;population\u0026nbsp;data\u0026nbsp;(CPD)\u0026nbsp;in\u0026nbsp;the management of sepsis. Ann Transl Med. 2020 Aug;8(15)\u003c/li\u003e\n \u003cli\u003eAddala TE, Greffier J, Hamard A, Snene F, Bobbia X, Bastide S, Belaouni A, de Forges\u0026nbsp;H,\u0026nbsp;Larbi\u0026nbsp;A,\u0026nbsp;de\u0026nbsp;la\u0026nbsp;Coussaye\u0026nbsp;JE,\u0026nbsp;Beregi\u0026nbsp;JP,\u0026nbsp;Claret\u0026nbsp;PG,\u0026nbsp;Frandon\u0026nbsp;J.\u0026nbsp;Early\u0026nbsp;results\u0026nbsp;of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg. 2022 Aug;12(8)\u003c/li\u003e\n \u003cli\u003eKim SJ, Bista AB, Min YG, Kim EY, Park KJ, Kang DK, Sun JS. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma. Medicine (Baltimore). 2017 Jan;96(2):e5888.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Alagic Z, Eriksson A, Drageryd E, Motamed SR, Wick MC. A new low-dose multi-phase trauma CT protocol and its impact on diagnostic assessment and radiation dose in multi-trauma patients. Emerg Radiol. 2017 Oct;24(5):509-518. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1- \u0026nbsp;Population characteristics and clinical features. \u003cem\u003eWBCT = whole-body computing imaging , SAP = systolic arterial pressure.\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere lesion on WBCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo severe lesion on WBCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhole population\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e301\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e505\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e806\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e84 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e147 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e231 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e42\u0026nbsp;(18 ;\u0026nbsp;92 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e31\u0026nbsp;(18 ;\u0026nbsp;95 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e35\u0026nbsp;(18 ;\u0026nbsp;95 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eSAP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e128 (\u0026plusmn;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e132 (\u0026plusmn;18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e130 (\u0026plusmn;19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eHeart rate (\u003csup\u003emin-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e85 (\u0026plusmn;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e86 (\u0026plusmn;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e85 (\u0026plusmn;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eSpO2 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e97 (\u0026plusmn;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e98 (\u0026plusmn;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e98 (\u0026plusmn;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eGlasgow score scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e15 (\u0026plusmn;0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e15 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e15 (\u0026plusmn;0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrauma mechanism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp;Traffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e256 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e457(91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e683 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; - Fall from more than 6 meters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e68 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e42 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003col start=\"110\"\u003e\n \u003cli\u003e(14%)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp;Stab wound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e4 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eAge over 75 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e21 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e14 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e35 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eAnticoagulant treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e13 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eDouble platelet antiaggregation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSevere comorbidity *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eDischarge from hospital\u003c/p\u003e\n \u003cp\u003eafter emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e74 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e448 (89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e522 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003eAdmission unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Medicine or surgery unit\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e145 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e50 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e195 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intensive care unit\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e82 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e87 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e30-days survival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e301 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e504 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e805 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 210px;\"\u003e\n \u003cp\u003e30-days readmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e13 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e*\u003c/em\u003e congenital heart disease, chronic respiratory insufficiency, haematological or neuromuscular diseases\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026ndash; Secondary outcomes. \u003cem\u003e3N = three times normal .\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere lesion on WBCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo severe lesion on WBCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eShock\u0026nbsp;index\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.7 (\u0026plusmn;0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e0.7 (\u0026plusmn;0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.7 (\u0026plusmn;0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eHemoglobin (g.dL\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e13.9 (\u0026plusmn;1.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e14.3 (\u0026plusmn;1.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14.1 (\u0026plusmn;1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eProthrombin time (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e90.8 (\u0026plusmn;12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e93.7 (\u0026plusmn;8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e92.6 (\u0026plusmn;9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eActivated\u0026nbsp;partial\u0026nbsp;thromboplastin\u0026nbsp;time (s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.9 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.0 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.9 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003ePlatelets count (G.L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e246.1 (\u0026plusmn;59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e254.3 (\u0026plusmn;67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e251.2 (\u0026plusmn;64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eCreatinine (\u0026micro;mol.L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e83.4 (\u0026plusmn;37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e75.9 (\u0026plusmn;16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e78.7 (\u0026plusmn;26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eHepatic cytolysis \u0026nbsp;\u0026gt; 3N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e18 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eCPK (mmol.L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e402.2 [254\u0026nbsp;;664]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e205 [119\u0026nbsp;;334]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e260 [144;490]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eCalcemia (mmol.L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2.2 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e2.2 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.2 (\u0026plusmn;0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"leukocytes, severe trauma, emergency care, biomarker, WBCT","lastPublishedDoi":"10.21203/rs.3.rs-6706216/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6706216/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Severe grade C trauma patients usually benefit from whole-body computed tomography (WBCT) to search for traumatic lesions, in the absence of clinical signs. The systematic use of WBCT in clinically stable patients with severe trauma remains controversial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: The aim of this study was to evaluate the diagnostic value of the blood leukocyte count in predicting the existence of traumatic lesions on WBCT in grade C severe trauma patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was an observational, retrospective, monocentric study of severe grade C trauma patients who underwent WBCT and leukocyte blood testing in the emergency department. The diagnosis of post-traumatic injury on WBCT was based on the detection of cranial, thoracic, abdominal, large-vessel, spinal and pelvic injuries. The primary endpoint was blood leukocyte count.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Eight hundred and six patients were included, 301 (37.3%) had severe traumatic lesions and 505 (62.7%) did not. The leukocyte count was significantly higher in patients with traumatic lesions than in those without (15.8 G.L\u003csup\u003e-1 \u003c/sup\u003e± 5.1 vs. 11.0 G.L\u003csup\u003e-1 \u003c/sup\u003e± 4.1; p\u0026lt;0.01). The AUC of the ROC curve derived from this sample was 0.79 [0.75; 0.82], corresponding to a good diagnostic value. Using the optimal threshold of 13.5 G L\u003csup\u003e-1 \u003c/sup\u003e\u0026nbsp;, sensitivity was 66% [60%; 71%], specificity 80% [77%; 84%], PPV\u0026nbsp; 67% [61%; 72%] and\u0026nbsp; NPV 80% [76%; 83%].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The leukocyte count on venous blood assay was significantly higher in severe grade C trauma patients with severe traumatic lesions on the WBCT, but doesn't seem to be a sufficient criterion to avoid WBCT. Its analysis coupled with other biological or clinical criteria could be studied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration : \u003c/strong\u003eThis study was approved by the local institutional review board (no. 24.02.01).\u003c/p\u003e","manuscriptTitle":"Can Leukocyte Count Predict the Presence of Post-traumatic Lesions on the Wbct in Clinically Stable Severe Trauma Patients ? A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 11:41:32","doi":"10.21203/rs.3.rs-6706216/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-24T05:12:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T09:08:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55853450345109269795466897580521589986","date":"2025-06-21T23:41:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T16:26:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168198952574821055893368755781955604488","date":"2025-06-10T06:04:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124797292360924056071968088659343944732","date":"2025-06-07T02:16:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T07:06:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-27T06:53:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-27T06:30:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-23T11:19:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-05-23T11:17:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd2650f6-2d7e-4f76-ba2f-c7a07fb36c8a","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T15:59:23+00:00","versionOfRecord":{"articleIdentity":"rs-6706216","link":"https://doi.org/10.1186/s12873-025-01384-9","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2025-11-12 15:56:56","publishedOnDateReadable":"November 12th, 2025"},"versionCreatedAt":"2025-06-02 11:41:32","video":"","vorDoi":"10.1186/s12873-025-01384-9","vorDoiUrl":"https://doi.org/10.1186/s12873-025-01384-9","workflowStages":[]},"version":"v1","identity":"rs-6706216","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6706216","identity":"rs-6706216","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}