Study design The REACT-2 trial is an international, multicenter randomized clinical trial in six high-volume trauma centers that will compare the effects of immediate total-body CT scanning in severely injured trauma patients with conventional imaging protocols. Setting In total four trauma centers in The Netherlands, one Swiss and one American trauma center will participate in the REACT-2 trial. All participating hospitals are level-1 trauma centers with a multi-slice CT scanner Inhibitors,research,lifescience,medical located in the trauma resuscitation room or at the ED. When a patient arrives in the trauma room a brief
report of the pre-hospital circumstances, medical assessment and clinically suspected injuries is presented to the trauma team leader by the ambulance personnel. The initial evaluation of trauma patients will be done according to the ATLS guidelines for the primary survey. Potential life-saving interventions during the primary survey and before any imaging include securing the airway by intubation or performing a cricothyrotomy, chest tube insertion, Inhibitors,research,lifescience,medical pericardiocenthesis or taking hemorrhage controlling Inhibitors,research,lifescience,medical measurements such as applying a pelvic binder or external pressure on bleeding sites to (temporarily) stabilize the vital functions. Usually, peripheral {TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor|TNF alpha inhibitor|TNF-alpha inhibitor| buy TNF-alpha inhibitor|TNF-alpha inhibitor ic50|TNF-alpha inhibitor price|TNF-alpha inhibitor cost|TNF-alpha inhibitor solubility dmso|TNF-alpha inhibitor purchase|TNF-alpha inhibitor manufacturer|TNF-alpha inhibitor research buy|TNF-alpha inhibitor order|TNF-alpha inhibitor mouse|TNF-alpha inhibitor chemical structure|TNF-alpha inhibitor mw|TNF-alpha inhibitor molecular weight|TNF-alpha inhibitor datasheet|TNF-alpha inhibitor supplier|TNF-alpha inhibitor in vitro|TNF-alpha inhibitor cell line|TNF-alpha inhibitor concentration|TNF-alpha inhibitor nmr|TNF-alpha inhibitor in vivo|TNF-alpha inhibitor clinical trial|TNF-alpha inhibitors|TNF-alpha signaling inhibitor|TNF-alpha pathway inhibitor|TNF-alpha signaling pathway inhibitor|TNF-alpha signaling inhibitors|TNF alpha pathway inhibitors|TNF-alpha signaling pathway inhibitors|TNF-alpha inhibitor library|TNF-alpha activity inhibition|TNF-alpha activity|TNF-alpha inhibition|TNF-alpha inhibitors library|TNF alpha inhibitor libraries|TNF-alpha inhibitor screening library|TNF-alpha high throughput screening|TNF-alpha inhibitors high throughput screening|TNF-alpha phosphorylation|TNF-alpha screening|TNF-alpha assay|TNF-alpha animal study| intravenous access is taken
care of by the ambulance personnel, but if not, at least one intravenous catheter will be inserted before radiologic imaging takes place. Based on information received from the ambulance personnel and the findings during primary survey, the trauma team Inhibitors,research,lifescience,medical leader decides on the eligibility of the patient to participate in the trial. If the patient is found to be eligible randomization takes place. Figure ​Figure11 depicts the study flow chart. Figure 1 Study flow chart REACT-2 trial. The intervention group Inhibitors,research,lifescience,medical will receive a total-body CT scan from head to pelvis. In the intervention group conventional radiography of the torso and FAST will be completely omitted. The CT protocol for the consists of a two-step
whole-body acquisition (from vertex to pubic symphysis) starting with Head and Neck Non Enhanced CT (NECT) with arms alongside the body. The preferred technique for the second complementary scan is a split-bolus intravenous contrast directly after repositioning of the arms alongside the head, and this second scan covers thorax, abdomen and pelvis. Participating centers however are free to choose their own technique as long as intravenous because contrast is given for the chest and abdominal part of the total-body CT. The control group will be evaluated according to a conventional trauma protocol with selective CT scanning. The REACT-2 trial has been designed to maximize the applicability of the trial’s results to usual care settings. Therefore, the technical details of the CT scanning done in the control group are not specified and participating centres follow their own protocols.