title: Effect of an image-sharing network on CT utilization for transferred trauma patients: a 5-year experience at a level I trauma center.
abstract: OBJECTIVE
  The aim of this study was to evaluate the influence of an image-sharing network established between referring hospitals and a level I trauma center on CT utilization at the trauma center.
  
  
  METHODS
  This retrospective study was approved by the local institutional review board. The requirement for informed consent was waived. Harborview Medical Center's trauma registry was linked to billing department data, and detailed information on all resources utilized during each patient's hospitalization was obtained. Negative binomial regression was used to evaluate body region-specific CT utilization between direct-admit and transfer patients after adjustment for potential confounding variables. Special attention was paid to 2005 as the year internet-based image sharing between Harborview Medical Center and referring hospitals was established.
  
  
  RESULTS
  A total of 81,159 trauma patients were admitted to Harborview Medical Center (44% transfers) during the study period. The utilization of head CT slightly increased from 1996 to 2005, with no significant difference between direct-admit and transfer patients. Between 2005 and 2010, utilization remained relatively unchanged; however, significantly higher utilization rates were observed for direct-admit patients. A relatively similar pattern was observed for pelvic CT; however, between 2005 and 2010, CT use was greater for direct-admit compared with transfer patients. Abdominal and thoracic CT was relatively unchanged between 2005 and 2010. However, both studies had significantly higher utilization rates for direct-admit patients.
  
  
  CONCLUSIONS
  The utilization rates of CT of different body regions have been higher for direct-admit trauma patients compared with transfer patients since 2005; however, decreasing utilization trends have been observed in recent years.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington. Electronic address: kevinp2@u.washington.edu.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Psoter
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington.
authors.forename: Bahman S
authors.initials: BS
authors.lastname: Roudsari
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Vaughn
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Fine
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Neurological Surgery, University of Washington, Seattle, Washington.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Gunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011873:Radiology Information Systems / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014861:Washington; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: CT; image sharing; imaging; information systems; patient transfers; trauma