title: Back to the future: reducing reliance on torso computed tomography in the initial evaluation of blunt trauma.
abstract: BACKGROUND
  Reliance on chest-abdomen-pelvis computed tomography (CAP) in the initial evaluation of blunt trauma is a major source of patient radiation exposure. Our trauma surgeon group (TSG) modified its practice to limit the use of CAP. We evaluated the effect of this practice change on patient radiation exposure and diagnostic accuracy.
  
  
  METHODS
  We compared data on blunt injury trauma activations evaluated by the five-member TSG for two 6-month intervals, before (T1) and after (T2) instituting the practice change. Patient demographic and injury data, complications, torso imaging and radiation dosage were collected. Following analysis of T1, the surgeon with the lowest CAP use was identified and found to have no errors or delays in diagnosis. The TSG agreed to adopt that surgeon's focus on findings of the physical examination and Focused Assessment Sonography for Trauma to reduce CAP use in the initial evaluation. T2 was analyzed to assess the effect of implementation of this guideline.
  
  
  RESULTS
  There were 897 patients in T1 and 948 in T2. In the two intervals, patients did not differ by age, sex, mortality, or probability of survival. CAP use decreased by 38.5% with a significant drop in mean patient radiation exposure (p < 0.001). There were no missed injuries or delays in diagnosis in either interval.
  
  
  CONCLUSIONS
  The use of CAP and its associated radiation burden in the initial evaluation of blunt trauma can be reduced without diagnostic errors by comparing use and identifying best practice. This process has implications for optimal trauma care.
  
  
  METHODS
  Diagnostic study, level IV; case management study, level IV.
authors.affiliation: Trauma Service, Scripps Mercy Hospital, San Diego, California 92103, USA. sise.mike@scrippshealth.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sise
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Kahl
authors.forename: Richard Y
authors.initials: RY
authors.lastname: Calvo
authors.forename: C Beth
authors.initials: CB
authors.lastname: Sise
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Steven R
authors.initials: SR
authors.lastname: Shackford
authors.forename: Meghan C
authors.initials: MC
authors.lastname: Shackford
authors.forename: Jesse
authors.initials: J
authors.lastname: Bandle
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Peck
authors.forename: Mark S
authors.initials: MS
authors.lastname: Schechter
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D060726:Torso / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*