title: Thoracoabdominal computed tomography in trauma patients: a cost-consequences analysis.
abstract: BACKGROUND
  CT is increasingly used during the initial evaluation of blunt trauma patients. In this era of increasing cost-awareness, the pros and cons of CT have to be assessed.
  
  
  OBJECTIVE
  This study was performed to evaluate cost-consequences of different diagnostic algorithms that use thoracoabdominal CT in primary evaluation of adult patients with high-energy blunt trauma.
  
  
  METHODS
  We compared three different algorithms in which CT was applied as an immediate diagnostic tool (rush CT), a diagnostic tool after limited conventional work-up (routine CT), and a selective tool (selective CT). Probabilities of detecting and missing clinically relevant injuries were retrospectively derived. We collected data on radiation exposure and performed a micro-cost analysis on a reference case-based approach.
  
  
  RESULTS
  Both rush and routine CT detected all thoracoabdominal injuries in 99.1% of the patients during primary evaluation (n = 1040). Selective CT missed one or more diagnoses in 11% of the patients in which a change of treatment was necessary in 4.8%. Rush CT algorithm costed € 2676 (US$ 3660) per patient with a mean radiation dose of 26.40 mSv per patient. Routine CT costed € 2815 (US$ 3850) and resulted in the same radiation exposure. Selective CT resulted in less radiation dose (23.23 mSv) and costed € 2771 (US$ 3790).
  
  
  CONCLUSIONS
  Rush CT seems to result in the least costs and is comparable in terms of radiation dose exposure and diagnostic certainty with routine CT after a limited conventional work-up. However, selective CT results in less radiation dose exposure but a slightly higher cost and less certainty.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Raoul
authors.initials: R
authors.lastname: van Vugt
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Digna R
authors.initials: DR
authors.lastname: Kool
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Brink
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Dekker
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Deunk
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
keywords: Abdomen; Costs and Cost Analysis; Thorax; Tomography, X-Ray Computed; Wounds and Injuries