To assess the risk of bias and concerns regarding the applicability of studies of diagnostic accuracy (KQ 1), 2 reviewers will independently assess the patient selection, index test, reference standard, and their flow and timing, based on the revised Quality Assessment of Diagnostic Accuracy Studies instrument tool (QUADAS-2).[41] We will assess 4 domains of study validity: participant selection, index test, reference standard test, and flow and timing thereof. A tailored version of the tool with details of the signaling questions, operational definitions, and rules for combining the answers to produce a domain-level rating are included in the supplementary file.

For diagnostic before-after studies that assessed diagnostic impact (KQ 2), we will assess study quality by using the original version of the Quality Assessment of Diagnostic Accuracy Studies instrument tool (QUADAS) tool with modifications proposed by Meads et al.[42] As recommended, we will apply the adapted QUADAS tool by considering conventional imaging-based assessment (i.e., the conventional primary survey followed by focused CT) and WBCT as the (hypothetical) index and reference standard tests, respectively.

To assess patient management and clinical outcomes (KQs 3, 4, and 7), we will use established quality assessment tools. Our main interest is the ITT effect of upfront use of WBCT (i.e., the effect of assignment to an upfront WBCT-based management at baseline) on mortality. Regarding NRSIs, we will use the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I tool).[43] We will assess 7 domains of study validity, i.e., confounding, participant selection, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selective reporting. RCTs, we will use the revised tool to assess risk of bias in randomized trials (RoB 2 tool).[44] We will assess 5 domains of trial validity, i.e., randomization processes, deviations from intended interventions, missing outcome data, measurement of outcomes, and selective reporting. We will prespecify age, GCS, SBP, RR, and ISS, and the TRISS and its variants as important mortality predictors and prediction models to consider, respectively.[45]

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