title: Physician utilization of a portable computed tomography scanner in the intensive care unit.
abstract: OBJECTIVE
  To determine the utilization of a portable computed tomography (CT) scanner for critically ill adult patients in an intensive care unit (ICU).
  
  
  METHODS
  Survey study and retrospective review.
  
  
  METHODS
  Critical care attending staff and fellows and neurosurgery residents.
  
  
  METHODS
  A university hospital and Level I trauma center with a multitrauma ICU, a neurotrauma ICU, and a neurosurgical ICU.
  
  
  METHODS
  We surveyed all physicians who ordered portable CT scans from December 1996 through June 1998. Ordering physicians included critical care attending staff and fellows (anesthesiology, surgery, internal medicine) and neurosurgery residents. Physicians who no longer worked at the institution were contacted by mail or fax. Radiology records were reviewed to determine the actual number and type of scans performed.
  
  
  RESULTS
  The survey response was 100%. Most physicians reported ordering portable head CT scans (97%), followed by chest CT (88%), abdominal CT (78%), and pelvic CT (34%) scans. Analysis of the actual number of scans performed correlated with these reports (511 head, 115 chest, 88 abdomen, and 87 pelvis). The indication for portable CT scans (as opposed to a "fixed" or "stationary" scans) cited most often was patient severity of illness (77%). Patients on extracorporeal support (93%), those with cardiovascular instability (70%), followed by those with respiratory instability (57%) and neurologic instability (40%) were deemed too ill to transport. If the portable CT scanner was unavailable, however, most physicians (67%) ordered a fixed helical CT scan and the patient was transported to the radiology suite, regardless of medical condition.
  
  
  CONCLUSIONS
  Access to a portable CT scanner impacts the physician ordering patterns for ICU patients. We found that 100% of surveyed physicians used the portable CT scanner for critically ill patients when the patient was unstable. If the diagnostic study was deemed medically necessary, and the portable scanner was unavailable, most surveyed physicians ordered a "fixed" helical scan and the patient was transported by an experienced transport team for the study. The portable CT offered an alternative and potentially safer means of obtaining diagnostic studies.
authors.affiliation: Department of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: M
authors.initials: M
authors.lastname: McCunn
authors.forename: S
authors.initials: S
authors.lastname: Mirvis
authors.forename: N
authors.initials: N
authors.lastname: Reynolds
authors.forename: C
authors.initials: C
authors.lastname: Cottingham
mesh_terms: D001291:Attitude of Health Personnel; D015142:Baltimore; D004867:Equipment Design; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital / Q000523:psychology; D018579:Patient Selection; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data; D014193:Trauma Centers