title: Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre.
abstract: BACKGROUND
  Cervical spine, thoracic and pelvic fractures are the main causes of devastation in patients who have suffered blunt trauma. Radiographic imaging plays an important role in diagnosing such injuries. Nevertheless, the present dominant approach, the routine use of X-ray studies, seems to have no cost-benefit justification for healthcare systems.
  
  
  METHODS
  This prospective cross-sectional study was performed over a 3-month period. During the determined time frame, all haemodynamically stable, high-energy blunt trauma patients were included. Based on the predefined criteria, selective radiographic images of the neck, chest and pelvis were obtained. Patients were followed during their hospital stay and for a 2-week period after discharge.
  
  
  RESULTS
  1002 cases were included in the final survey. 247/1002 (24.6%) cervical radiographic images, 500/1002 (49.9%) CXRs and 171/1002 (17%) pelvic radiographic images of the patients were taken on the first day of hospital admission. New X-ray images required during the patients' hospital stay resulted in 5/1002 (0.4%) cervical, 4/1002 (0.3%) chest and 8/1002 (0.7%) pelvic radiographies. In the 2-week period after discharge, 4/1002 cases (0.3%) needed to repeat neck radiography. Overall, 697.44 mSv X-ray radiation was potentially prevented and US$426,450 were potentially saved.
  
  
  CONCLUSIONS
  Selective radiographic imaging of the neck, chest and pelvis together with a precise history-taking and physical examination in cases of high-energy blunt trauma could eliminate unnecessary costs to patients and healthcare systems, and significantly save resources.
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Paydar
authors.affiliation: Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Armin
authors.initials: A
authors.lastname: Ahmadi
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Behnam
authors.initials: B
authors.lastname: Dalfardi
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Shakibafard
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Abbasi
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Bolandparvaz
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000191:economics; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000191:economics; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries*; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000191:economics; D055815:Young Adult
keywords: Cost Effectiveness; Diagnosis