Imaging May Delay Transfer of Rural Trauma Victims: A Survey of Referring Physicians

Abstract

Factors other than patient care dictate imaging acquisition in almost half of those surveyed. Misperception of expectations, misunderstanding of legal imperatives, and liability concerns all delay transport of the injured. ATLS-certified individuals use imaging more appropriately, thus, promoting more timely transfer. State-wide protocols, education, and liability reform may reduce transport delays.

Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation

“…These guidelines are continually revised to adopt changes in technologies and techniques to improve patient outcomes (30,31). In the pediatric population, if the trauma is deemed severe enough to warrant transfer to a pediatric trauma center (PTC), ATLS guidelines recommend to promptly transfer the patient without any delay, even without imaging.…”

Unnecessary Imaging, Not Hospital Distance, or Transportation Mode Impacts Delays in the Transfer of Injured Children

“…Examples of these nonclinical reasons included a misunderstanding of legal requirements, perceived expectations of the receiving trauma center, and concern about medical liability. 27 It is also possible that some of the CT imaging was obtained while waiting for a transport team or helicopter and therefore not the source of the delay but rather a consequence of a delay in the system.…”

Effect of an Image-Sharing Network on CT Utilization for Transferred Trauma Patients: A 5-Year Experience at a Level I Trauma Center

“…Moreover, approximately 20% of all referred patients have at least one CT scan repeated upon admission [13]. The impact of delaying transfer for imaging purposes (performing or obtaining images) can result in delay in treatment without any realized patient benefits [14-16]. Lee et al conducted a survey of referring physicians and found that approximately 30% of the referring physicians believed that trauma centers require pre-referral images [16].…”

“…The impact of delaying transfer for imaging purposes (performing or obtaining images) can result in delay in treatment without any realized patient benefits [14-16]. Lee et al conducted a survey of referring physicians and found that approximately 30% of the referring physicians believed that trauma centers require pre-referral images [16]. Concerns regarding liability issues and financial interests of referring centers are among other factors that contribute to pre-referral imaging.…”