Consequences of increased use of computed tomography imaging for trauma patients in rural referring hospitals prior to transfer to a regional trauma centre.
BACKGROUND
Computed tomography (CT) plays an integral role in the evaluation and management of trauma patients. As the number of referring hospital (RH)-based CT scanners increased, so has their utilization in trauma patients before transfer. We hypothesized that this has resulted in increased time at RH, image duplication, and radiation dose.


METHODS
A retrospective chart review was completed for trauma activations transferred to an ACS-verified Level II Trauma Centre (TC) during two time periods: 2002-2004 (Group 1) and 2006-2008 (Group 2). 2005 data were excluded as this marked the transition period for acquisition of hospital-based CT scanners in RH. Statistical analysis included t test and χ(2) analysis. P<0.05 was considered significant.


RESULTS
1017 patients met study criteria: 503 in group 1 and 514 in group 2. Mean age was greater in group 2 compared to group 1 (40.3 versus 37.4, respectively; P=0.028). There were 115 patients in group 1 versus 202 patients in group 2 who underwent CT imaging at RH (P<0.001). Conversely, 326 patients in group 1 had CT scans performed at the TC versus 258 patients in group 2 (P<0.001). Mean time at the RH was similar between the groups (117.1 and 112.3min for group 1 and 2, respectively; P=0.561). However, when comparing patients with and without a pretransfer CT at the RH, the median time at RH was 140 versus 67min, respectively (P<0.001). The number of patients with duplicate CT imaging (n=34 in group 1 and n=42 in group 2) was not significantly different between the two time periods (P=0.392). Head CTs comprised the majority of duplicate CT imaging in both time periods (82.4% in group 1 and 90.5% in group 2). Mean total estimated radiation dose per patient was not significantly different between the two groups (group 1=8.4mSv versus group 2=7.8mSv; P=0.192).


CONCLUSIONS
A significant increase in CT imaging at the RH prior to transfer to the TC was observed over the study periods. No associated increases in mean time at the RH, image duplication at TC, total estimated radiation dose per patient, and mortality rate were observed.
Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Timothy J
TJ
Berkseth
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Michelle A
MA
Mathiason
Department of Diagnostic Physics, Gundersen Health System, La Crosse, WI, USA.
Mary Ellen
ME
Jafari
Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI, USA. Electronic address: thcogbil@gundersenhealth.org.
Thomas H
TH
Cogbill
Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI, USA.
Nirav Y
NY
Patel
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D017408:Guidelines as Topic; D006780:Hospitals, Rural; D006801:Humans; D033181:Information Dissemination; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000706:statistics & numerical data; D014193:Trauma Centers; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality
Computed tomography; Critical care; Diagnostic imaging; Radiation exposure; Referral hospital; Trauma centres