title: Repeated computed tomographic scans in transferred trauma patients:  Indications, costs, and radiation exposure.
abstract: BACKGROUND
  Trauma patients are often transferred to regional Level I trauma centers from other institutions. At times, when the patient presents to the trauma center, radiologic studies performed at the previous institution are repeated. The aim of this study was to assess the proportion of computed tomographic (CT) scans repeated in trauma patients receiving CT scans before transfer and to obtain the indications for these repeats. This study also estimated the additional radiation dose and economic burden associated with repeated CT scans.
  
  
  METHODS
  This prospective, observational cohort study collected data consecutively on transferred trauma patients who had received a CT scan at the transferring institution and investigated whether the CT scan was repeated at the receiving institution. Indications for repeating CT scans were obtained from the general surgery trauma service. The economic impacts were assessed using fee schedules from the hospital and the Center of Medicare and Medicaid Services. Effective dose radiation was estimated using the dose-length product method.
  
  
  RESULTS
  Of the 211 patients who presented with a previous CT scan at the transferring institution, 82 had at least one repeated CT scan. Indications for repeating CT scans varied based on the body region. Additional hospital charges ranged from $728 to $5,892 with an average of $1,762.40 for patients having one or more repeated CT scans. The estimated additional effective dose radiation ranged from 1.2 mSv to 124 mSv with an average of 21.5 mSv.
  
  
  CONCLUSIONS
  This study reveals the high rates of repeated CT scans in transferred trauma patients and the various indications that lead to them. Additional hospital charges and additional low levels of radiation exposure are a consequence of these repeats.
  
  
  METHODS
  Diagnostic study, level IV.
authors.affiliation: Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, USA. ajones@hsc.wvu.edu
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Jones
authors.forename: Dawit
authors.initials: D
authors.lastname: Woldemikael
authors.forename: Teresa
authors.initials: T
authors.lastname: Fisher
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Hobbs
authors.forename: Bonhomme Joseph
authors.initials: BJ
authors.lastname: Prud'homme
authors.forename: George K
authors.initials: GK
authors.lastname: Bal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult