title: Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes.
abstract: BACKGROUND
  Computed tomography (CT) of injured patients in the radiology department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow.
  
  
  METHODS
  A randomized trial compared the effect of locating a CT scanner in the trauma room versus the radiology department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI).
  
  
  RESULTS
  Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P < 0.001). Patient transfers and transports were reduced by more than half in the intervention group. For both multiple trauma (265 patients) and TBI (121) subgroups, differences in mortality and out-of-hospital days favoured the intervention group, but were not statistically significant.
  
  
  CONCLUSIONS
  A CT scanner located in the trauma room reduces the time to acquire CT images and improves workflow, but does not lead to substantial improvements in clinical outcomes in a general trauma population. Observed beneficial effects on outcomes in patients with multiple trauma or severe TBI were not statistically significant.
  
  
  BACKGROUND
  ISRCTN55332315 (http://www.controlled-trials.com).
authors.affiliation: Trauma Unit, Department of Surgery, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: Saltzherr
authors.forename: F C
authors.initials: FC
authors.lastname: Bakker
authors.forename: L F M
authors.initials: LF
authors.lastname: Beenen
authors.forename: M G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: J B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011872:Radiology Department, Hospital; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000401:mortality; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality