title: Inefficiencies in a rural trauma system: the burden of repeat imaging in interfacility transfers.
abstract: BACKGROUND
  Local hospitals (LHs) transferring patients to regional trauma centers (TCs) often obtain CT scans to diagnose injuries and justify transfer. However, these imaging studies are often repeated at the receiving TCs. This study was performed to examine how frequently computed tomography (CT) scans were repeated in interfacility transfers in a rural trauma system and to identify the most common reason for repeating the studies.
  
  
  METHODS
  Patients transferred to a rural Level I TC from October 2007 through February 2008 were prospectively evaluated. Data abstracted included CT scans performed at LHs and CT scans repeated at the TC. Additionally, the reason for repeating each study was recorded as follows: (1) scan not sent, (2) software not compatible, (3) inadequate technique (no intravenous contrast), (4) inadequate technique (no reconstructions), and (5) clinically indicated.
  
  
  RESULTS
  During the study period, 138 patients were transferred to the TC. Of these, 104 (75%) underwent CT imaging before transfer. Sixty of these patients (58%) underwent repeat CT imaging at the TC. Overall, 98 of 243 (40%) scans were repeated. Head CT scans were repeated predominantly because of clinical indications. All other body region CT scans were repeated predominantly because of inadequate technique at the LHs.
  
  
  CONCLUSIONS
  CT scans were repeated in 58% of interfacility transfers. Repeat CT scans inevitably result in increased radiation exposure to patients as well as additional charges and may be an important patient safety and cost issue for trauma systems.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. rajan.gupta@dartmouth.edu
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greer
authors.forename: Eric D
authors.initials: ED
authors.lastname: Martin
mesh_terms: D003952:Diagnostic Imaging / Q000706:statistics & numerical data* / Q000639:trends; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005260:Female; D006780:Hospitals, Rural / Q000458:organization & administration; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D020380:Needs Assessment; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data / Q000639:trends; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States; D019564:Unnecessary Procedures; D014947:Wounds and Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*