Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol.
OBJECTIVE
To compare the proportion of patients exposed to a radiation dose in excess of 20 mSv, and to document missed injuries before and after the introduction of a panscan protocol for blunt trauma.


METHODS
Data were collected retrospectively from our trauma database for 6 months before and after implementation of the protocol. All radiological studies performed during the initial patient assessment were identified. Radiation doses for each patient were calculated. Subgroup analyses were age ≤30 and >30 years, injury severity score (ISS) <16 and ≥16, and patient disposition as discharged from ED or admitted.


RESULTS
There were 656 patients before and 624 after the introduction of the protocol. The proportion of patients exposed to a radiation dose >20 mSv increased by 8% (95% confidence interval [CI] 4-12), which equated to one extra person being exposed to >20 mSv for every 13 patients treated after the introduction of the protocol. The odds of receiving a radiation dose >20 mSv after the introduction of the protocol compared with the odds before were increased across all subgroups (≤30 years: odds ratio [OR] 2.7, 95% CI 1.3-5.8, P = 0.008; >30 years: OR 2.2, 95% CI 1.5-3.4, P < 0.001; ISS < 16: OR 2.4, 95% CI 1.5-3.9, P < 0.001; ISS ≥ 16: OR 2.0, 95% CI 1.0-3.7, P = 0.04; discharged home: OR 2.1, 95% CI 0.7-6.0, P = 0.17; admitted: OR 2.2, 95% CI 1.5-3.3, P < 0.001). There were six missed injuries before and four after.


CONCLUSIONS
Introduction of a panscan protocol increased the proportion of trauma patients receiving a radiation dose >20 mSv. This increased risk occurred regardless of age or injury severity.
Emergency Department, St George Hospital, Sydney, New South Wales, Australia. stephen.asha@sesiahs.health.nsw.gov.au
Stephen
S
Asha
Kate Anne
KA
Curtis
Nicole
N
Grant
Colman
C
Taylor
Serigne
S
Lo
Richard
R
Smart
Katherine
K
Compagnoni
D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D016017:Odds Ratio; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult