title: Evidence-based guidelines are equivalent to a liberal computed tomography scan protocol for initial patient evaluation but are associated with decreased computed tomography scan use, cost, and radiation exposure.
abstract: BACKGROUND
  We hypothesized that trauma patient evaluations using evidence-based treatment guidelines (evidence-based group [EBG]), which include serial examinations and limited computed tomography (CT) scans in an established trauma center, would be associated with equivalent outcomes but with decreased CT scan usage, decreased cost, and less radiation exposure compared with a liberal CT scan approach (conventional group [CONV]).
  
  
  METHODS
  Fifteen evidence-based treatment guidelines were developed using published literature and in collaboration with other institutional departments. These were implemented on July 1, 2010. Prospectively collected data during a 4-month period were compared with a similar period in 2008 when CONV was used.
  
  
  RESULTS
  In 2010 (EBG), there were 611 patients compared with 612 in 2008 (CONV). Their average Injury Severity Score was 11.93 versus 8.77 (p < 0.0001), and the total CT scans were 757 and 1194, respectively (p < 0.001). The average APACHE II and hospital length of stay did not significantly vary. No missed or delayed injuries were identified. Estimated CT scan charges were $1,842,534 versus $2,935,024. The average number of scans per patient were 1.2 (EBG) versus 1.9 (CONV). Regarding radiation dosimetry, the estimated average computed tomography dose index (CTDI) per patient were 36.7 versus 53.31 mGy, and the estimated average dose-length product per patient were 889.91 versus 1364.11 mGy·cm.
  
  
  CONCLUSIONS
  EBG, including serial examinations, provided equivalent diagnostic data to CONV for initial workup but reduced CT scan usage, CT scan charges, and average radiation exposure per patient. This strategy may be beneficial in institutions where serial monitoring can be assiduously provided.
  
  
  METHODS
  Case management study, level IV.
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston, Massachusetts02118, USA. eric.mahoney@bmc.org
authors.forename: Eric
authors.initials: E
authors.lastname: Mahoney
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
authors.forename: Baojun
authors.initials: B
authors.lastname: Li
authors.forename: Tracey
authors.initials: T
authors.lastname: Dechert
authors.forename: John
authors.initials: J
authors.lastname: Abbensetts
authors.forename: Andrew
authors.initials: A
authors.lastname: Glantz
authors.forename: Alan
authors.initials: A
authors.lastname: Sherburne
authors.forename: Dinesh
authors.initials: D
authors.lastname: Kurian
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D011786:Quality Control; D011829:Radiation Dosage; D011830:Radiation Effects; D011874:Radiometry / Q000379:methods; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics* / Q000592:standards*; D014193:Trauma Centers / Q000191:economics / Q000592:standards; D014481:United States; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000191:economics; D055815:Young Adult