Airway, breathing, computed tomographic scanning

Moore, Hunter B.; Loomis, Scott B.; DeStigter, Kristen K.; Mann-Gow, Travis; Dorf, L.; Streeter, Mary; Ebert, George; Crookes, Bruce; Leffler, Stephen M.; O’Keefe, Michael F.; Freeman, Kalev

doi:10.1097/ta.0b013e3182789399

Cited by 30 publications

(19 citation statements)

References 18 publications

(19 reference statements)

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“…1 ), by reducing unnecessary repeat CTs should have a positive effect on transfer time, patient care costs, and radiation exposure. This is corroborated in the literature, where PACS implementation between hospitals shows reduction in the duplicate CT rates in trauma transfers [ 13 , 23 ]. Furthermore, the literature shows reducing duplicate CT rates that reduces patient exposure and care costs [ 3 ].…”

Section: Discussionsupporting

confidence: 76%

Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center

et al. 2018

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PurposeThe regionalization of trauma in the USA results in frequent transfers of patients from a primary hospital ED to a higher level trauma facility. While many hospitals have a Picture Archive Communication System (PACS) which captures digital radiological images, these are often not available to the receiving institution resulting in duplicate imaging. The state of Arkansas instituted a trauma image repository (TIR) in July 2013. We examined whether implementation of this repository would impact CT scan duplication in the trauma system.MethodsThis was a retrospective analysis of trauma patients transferred from outlying hospitals in Arkansas and Missouri to a single level 1 trauma hospital in Missouri between July 2012 and June 2015. We compared the duplicate CT rate for patients transferred from Arkansas and Missouri hospitals before and after the repository was implemented for Arkansas.ResultsPrior to implementation (July 2012–June 2013) of Arkansas TIR, duplicate CT rates were similar for patients transferred from Arkansas (11.5% ± 2.8) or Missouri (16.3% ± 7.5). Following implementation (July 2013–June 2014), the duplicate CT rate for patients transferred from Arkansas was significantly lower (Arkansas = 10.1% vs. Missouri 16.2%; CI 95%, p = 0.02), and significance continued (Arkansas = 9.0% vs. Missouri = 17.8%; CI 95%, p = 0.02) during follow-up (July 2014–June 2015).ConclusionFewer patients received duplicated scans within the Arkansas as compared with the Missouri-based trauma referral systems regardless of Injury Severity Scores (ISS). Our findings suggest that TIR adoption coupled with PACS improved transferability of radiographic studies and could improve patient care while reducing costs in trauma transfers.

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Section: Discussionsupporting

confidence: 76%

Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center

et al. 2018

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“…The risk of bias was determined to be moderate in 13 studies 13–16,18,20,21,23–25,27,28,30 and high in four studies. 19,22,26,31 Only two studies 17,29 were considered to have a low risk of bias. Prominent flaws included the lack of reporting of response rates in surveys and the lack of use of validated tools for data collection.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies described scans duplicated in patients arriving at a level 1 trauma center after transfer. 13–16,19,22–24,26,28,29,31 Two studies described acquisition of scans at the referring facility prior to emergent transfer. 17,25…”

Section: Resultsmentioning

confidence: 99%

“…Eight out of 12 studies of duplicate scans upon arrival probed the reasons for ordering the duplicated scan; this was learned either by survey, 22 by medical record review 13,19,26,29,31 or by medical record review with adjunctive physician report. 23,24 (Table 2) Two reasons were noted in all eight studies: 1) the scan was not received by the trauma center or there was inadequate transfer of data; and 2) the quality of the transferred image was inadequate for clinical care.…”

Section: Resultsmentioning

confidence: 99%

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Factors associated with imaging overuse in the emergency department: A systematic review

Tung

Sharma

Hinson

et al. 2018

The American Journal of Emergency Medicine

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“…[ 9 ] Radiation exposure is often further increased in patients transferred to designated trauma centers from other hospitals due to inefficiencies in diagnostic image transfer. [ 10 11 12 ]…”

Section: Introductionmentioning

confidence: 99%

"Occult" rib fractures diagnosed on computed tomography scan only are still a risk factor for solid organ injury

Bhattacharya

Fieber

Schuster

et al. 2015

J Emerg Trauma Shock

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Introduction:Prior to the widespread use of computed tomography (CT) scan imaging, lower rib fractures diagnosed on chest X-rays (CXRs) were considered a risk factor for abdominal solid organ injury (ASOI). However, CXRs miss about 50% of the rib fractures that are detected on CT scans. We hypothesized that these “occult” rib fractures would not be predictive for ASOI.Materials and Methods:Retrospective review of a level I trauma center's database identified all adult blunt trauma patients (n = 11,170) over a 5-year period. Data were abstracted for demographics, injury severity score, presence of ASOI, extremity, pelvic and spine fractures as well as presence and location of rib fractures.Results:Rib fractures correlated with the presence of ASOI, regardless of whether they were diagnosed by CXR or CT scan alone (P < 0.01). Middle (3-7) and lower (8-12) rib fractures, especially, correlated with the presence of ipsilateral ASOI (P < 0.0001).Discussion:Although CT scan detects more rib fractures than CXR, rib fractures remain a marker for increased likelihood of ASOI regardless of the modality by which they are diagnosed. Patients with rib fractures also have a greater incidence of spine and pelvic fractures. As the trauma community debates moving away from routine whole-body CT imaging towards a more selective approach, these results suggest that any clinical suspicion of rib fractures, despite a negative CXR, may warrant further investigation.

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Airway, breathing, computed tomographic scanning

Cited by 30 publications

References 18 publications

Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center

Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center

Factors associated with imaging overuse in the emergency department: A systematic review

"Occult" rib fractures diagnosed on computed tomography scan only are still a risk factor for solid organ injury

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