Radiation exposure has increased in trauma patients over time.
BACKGROUND
Computed tomography (CT) scans have become imaging modalities of choice in trauma centers. The purposes of this study were to evaluate the trend of radiation exposure in acute trauma patients. Our hypothesis was that radiation dosage and charges would increase over time without change in patient acuity or outcome.


METHODS
Five hundred consecutive trauma patients were retrospectively reviewed for the years 2002, 2005, and 2008. Total number of CT scans, plain radiographs, and total radiation dosage (milliSieverts [mSV]) were determined. Charges were calculated. Injury severity scores and mortality were determined.


RESULTS
The mean number of CT scans for category 1 patients in 2002, 2005, and 2008 was 1.5, 3.1, and 4.6, respectively (p = 0.01). This trend was similar in category 2 patients: 2.0, 3.5, 5.1, respectively (p < 0.01). Significant decreases in plain radiography were noted concurrently. This contributed to increased total radiation exposure to categories 1 and 2 patients over 2002, 2005, and 2008: 12.0 mSV, 23.6 mSV, and 33.6 mSV (p = 0.02); and 17.5 mSV, 24.1 mSV, and 37.5 mSV (p < 0.001), respectively. Charges for diagnostic imaging per patient also increased for categories 1 and 2 patients over 2002, 2005, and 2008: $2,933, $4,656, and $6,677; and $4,105, $5,344, and $7,365, respectively (all p < 0.01). Over the course of a year for 4,800 trauma patients treated at our hospital, this is expected to accrue additional charges of $13 million.


CONCLUSIONS
The number of CT scans per trauma patient has more than doubled over 6 years, generating more radiation exposure and charges per patient, despite no change in mortality or injury severity. Judicious use of advanced imaging may control risks and costs without compromising care.


METHODS
III, retrospective.
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Kasra
K
Ahmadinia
J Benjamin
JB
Smucker
Clyde L
CL
Nash
Heather A
HA
Vallier
D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011829:Radiation Dosage; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality