Research Activities March 2013, No. 391
Trauma patients often receive repeat CT imaging that increases radiation exposure and costs
The quick transfer of injured patients to a trauma center that can provide timely surgery should be done as efficiently as possible. However, the initial assessment of trauma patients often includes ordering imaging studies, such as computed tomography (CT). In fact, a new study shows that trauma patients often undergo repeat CT scans after they are transferred to a trauma center. While these patients had no different outcomes, they did have substantially higher health care costs and patients were exposed to double the amount of radiation, exposing them to potential long-term risks, note the researchers. They suggest that repetitive imaging can be avoided by more hospitals using systems that allow the transfer of images electronically from the referring institution to the trauma center.
The researchers reviewed the medical records of 2,543 patients who were transferred to two trauma centers during a 4.5 year period to examine how common repetitive CT imaging of the chest and abdomen is performed in trauma patients. All patients had received an abdominal or chest CT (or both) during their trauma evaluation. Data collected included the mechanism and magnitude of the injuries, time intervals, and in-hospital mortality. After arrival at the trauma center, 60 percent of patients had one or more CT studies repeated. Factors associated with repeat imaging indicated more severe injury. Arrival via helicopter, shorter transport times, and shorter time spent at the referring hospital were other factors associated with greater odds of repeat imaging. Patients who received a scan at the referring hospital spent longer time there before being transferred to the trauma center.
Repeat imaging added up to 25 minutes of delay at the trauma center. Those patients who underwent repeated CT scans tended to have longer intensive care unit and hospital stays. They were also more likely to be discharged to somewhere other than home, but had similar mortality rates. The study was supported in part by the Agency for Healthcare Research and Quality (HS00032). See "Repeat imaging in trauma transfers: A retrospective analysis of computed tomography scans repeated upon arrival to a Level I trauma center," by Dawn M. Emick, M.D., M.P.H., Timothy S. Carey, M.D., M.P.H., Anthony G. Charles, M.D., M.P.H., and Mark L. Shapiro, M.D., in the Journal of Trauma 72(5), pp. 1255-1262, 2012.