Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients transferred for minor trauma

Abstract

Many clinicians order focused computed tomography (CT) examinations for trauma patients based on history and physical examinations. Trauma patients transferred to our level I trauma center undergo an extensive, nonfocused standard trauma CT protocol. We hypothesize that the use of the standard trauma CT protocol does not contribute significant clinical information for patient care when compared with CT examinations based on history and physical examination. We aim to quantify the utility of the additional CT examinations required by our institution's trauma protocol compared with emergent CT examinations dictated by the patient's history and physical examination findings. In this IRB-approved study, we retrospectively evaluated 132 trauma patients transferred to our center who underwent additional CT examinations as determined by fulfillment of our institution's standard trauma CT protocol. The emergency radiologist evaluated the CT examinations acquired after the patient's transfer to determine if there were any additional acute findings that were identified on these additional examinations compared with the initial assessment undertaken at the outside institution. A total of 101 patients transferred to our trauma center met inclusion criteria. The majority of these patients sustained minor trauma. The standard trauma protocol generated 474 negative CT examinations in 101 patients. In seven patients, there were unexpected acute findings. However, these unexpected acute findings did not change clinical management in any of the patients. After initial evaluation, the acquisition of additional nonfocused CT examinations based on the standard trauma CT protocol provides little useful clinical information in patients who are transferred for minor trauma. Rather, CT utilization should be based on clinical findings. Replacement of standard trauma CT protocol with focused CT examinations in trauma patients is a way to curtail overutilization, thereby decreasing health care cost and the amount of patient radiation exposure.

Comparative Effectiveness Research: Alternatives to “Traditional” Computed Tomography Use in the Acute Care Setting

“…Although CT scanning for ED trauma evaluation rose more than fourfold between 2000 and 2007, outpacing overall CT growth in the ED, there does not appear to have been an accompanying increase in the diagnostic prevalence of life‐threatening conditions during this time . Nevertheless, CT (including whole‐body CT) is often routinely recommended in trauma, with wide practice variation seen geographically and by specialty . CT scanning for trauma occurs disproportionately in younger patients, who may be more susceptible to radiation.…”

“…Patients in these positive studies were included if they had significantly altered mental status and/or high injury severity scores, which represents a relatively small subset of all trauma patients. Further studies comparing the benefits of “panscan” versus targeted imaging of body regions are needed that take into account morbidity, mortality, radiation exposure, expense, cost, and potential for incidental or clinically insignificant findings …”

Evaluation of the Whole Body Scanner in the Management of Severe Traumas at Armentieres Hospital Centre (France): Scanographic and Clinical Correlation about 180 Cases

“…According to BABAUD et al, the proportion of abnormal whole body scanner is significantly higher in the group of patients who received a targeted scan than those who received a justified whole body scanner only by the presence of Vittel criterion [3]. On the other hand, HELLER et al in 2014 got, out of 481 whole body scanner oriented by anamnesis and clinic, only 1.5% of lesions with only minor traumas lesion [13]. Our figures are lower than those obtained by OBERLIN et al, who found in their multifaceted study 55.8% of computed tomography lesions in a population of 429 patients based on TRENAU classification who correct the parameters of Vittel criteria [10].…”

Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

“…This has led some centers to use CT scanning of the torso liberally [5][6][7][8][9]. Whereas others advocate for use in selected patients [10,11]. Advocates of selective CT for trauma argue that the benefits do not outweigh the complications, which include IV contrast issues, radiation exposure, and cost [12][13][14].…”