Time factors associated with CT scan usage in trauma patients.
BACKGROUND
While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase.


METHODS
During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance.


RESULTS
Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9 min. Median start time for the first CT scan was 82 min. The first CT session was completed in a median of 105 min after arrival. Complete radiological workup was finished in 114 min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging.


CONCLUSIONS
In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114 min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imaging.
Fung Kon Jin
P H P
PH
Trauma Unit Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. p.fungkonjin@amc.uva.nl
van Geene
A R
AR
Linnau
K F
KF
Jurkovich
G J
GJ
Ponsen
K J
KJ
Goslings
J C
JC
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014600:Utilization Review; D014861:Washington / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult