title: The use of technology to reduce radiation exposure in trauma patients transferred to a level I trauma center.
abstract: BACKGROUND
  Patients with traumatic injuries transferred from rural hospitals to tertiary centers in West Virginia frequently undergo repeat computed axial tomography (CT) imaging upon arrival. The traditional method of sending images on a compact disc (CD) with EMS can be unreliable due to software incompatibility, CD malfunction, or misplacement of the CD. Given the known risks associated with ionizing radiation, physicians are increasingly aware of the need to avoid unnecessary CT imaging. Image storage applications such as ImageGrid provide a means to store images securely without the issues and inherent problems of a CD. These images can be uploaded at the referring hospital and may be viewed from any computer at the receiving facility, by multiple providers--even prior to patient arrival. The goal of this study was to determine if utilizing ImageGrid compared to traditional data transfer by CD resulted in a decrease in the amount and type of images obtained in the initial Emergency Department (ED) evaluation at the tertiary center.
  
  
  METHODS
  We analyzed data from the Jon Michael Moore Trauma Registry for patients transferred to the Emergency Department at WVU Hospitals from an outside facility. Two study periods were reviewed; prior to ImageGrid implementation and after implementation of the system. Medical records of all patients admitted to the Trauma Surgery Service after a trauma system activation in the ED were reviewed during these time periods. Number and type of CT studies obtained in the Emergency Department were recorded for analysis.
  
  
  RESULTS
  In the month of July 2010, 183 patients were admitted to the Trauma Surgery service after trauma team activation. Transfers from referring hospitals accounted for 77 of the 108 (42.1%). WVU Hospitals implemented ImageGrid during 2011. In July 2012, 243 patients were admitted to the Trauma Service, of which 105 (41.1%) were transfer patients. After implementation of ImageGridTM there was a significant decrease in the number of repeat CT Scans of the brain (19/27 [70.4%] vs. 18/40 [45.0%], p < .05), as well as CT scans of the chest, abdomen or chest/ abdomen/pelvis (9/18 [50.0%] vs. 2/23 [8.7%], p < .05). CT of the face showed a decreasing trend (5/9 [55.6%] vs. 1/9 [11%], p > .05 [p = 0.06]), but did not achieve statistical significance. After implementation of ImageGrid there was a marked decrease in total CT scans repeated (46/79 [58.2%] vs. 28/107 [26.2%], p < .05).
  
  
  CONCLUSIONS
  In West Virginia, the use of image archival systems such as ImageGrid appears to result in less repeat CT imaging upon arrival at a tertiary trauma center. Given risks associated with ionizing radiation and costs of repeat imaging the benefits have important implications for patient safety and cost containment.
authors.forename: Charles
authors.initials: C
authors.lastname: Whiteman
authors.forename: Christopher
authors.initials: C
authors.lastname: Kiefer
authors.forename: John
authors.initials: J
authors.lastname: D'Angelo
authors.forename: Danielle
authors.initials: D
authors.lastname: Davidov
authors.forename: Hollynn
authors.initials: H
authors.lastname: Larrabee
authors.forename: Steve
authors.initials: S
authors.lastname: Davis
mesh_terms: D006780:Hospitals, Rural; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D010360:Patient Transfer; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D012042:Registries; D012189:Retrospective Studies; D019112:Teleradiology / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data; D014193:Trauma Centers; D014903:West Virginia; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*