title: Changes in thoracolumbar computed tomography and radiography utilization among trauma patients after deployment of multidetector computed tomography in the emergency department.
abstract: BACKGROUND
  Diagnostic-quality thoracolumbar spine (TLS) images, generated from routine thoracoabdominal multidetector computed tomography (MDCT) data, have been demonstrated superior to conventional radiography (CR) for TLS injury. We evaluated thoracoabdominal computed tomography (CT) and TLS utilization among trauma patients after deployment of MDCT. We hypothesized that reformatted MDCT images replaced CR for evaluation of TLS trauma among patients undergoing chest or abdominal CT, and that utilization of thoracoabdominal CT and TLS screening in trauma increased postMDCT.
  
  
  METHODS
  We reviewed all TLS imaging for trauma patients undergoing chest or abdominal CT for 18 months pre- and postMDCT. We compared the relative use of CR and CT in TLS imaging, and the volume of TLS screening, and chest and abdominal CT across the study period. We also reviewed TLS CR in patients not undergoing chest or abdominal CT.
  
  
  RESULTS
  After MDCT deployment, CT replaced CR for TLS imaging among those undergoing chest or abdominal CT for trauma. Utilization of chest and abdominal CT and TLS screening significantly increased, despite unchanged volume and severity of trauma patients during the study period. There was a corresponding decrease in patients evaluated with thoracic spine CR alone
  
  
  CONCLUSIONS
  Reformatted TLS images using thoracoabdominal CT data have replaced CR in our evaluation of TLS trauma. However, reasons for increased utilization remain unclear. Further studies are needed to determine whether clinical yield and cost-effectiveness warrant these changes in utilization.
authors.affiliation: Center for Evidence-Based Imaging, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. rgriffey@partners.org
authors.forename: Richard T
authors.initials: RT
authors.lastname: Griffey
authors.forename: Stephen
authors.initials: S
authors.lastname: Ledbetter
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices