title: Radiation fear: Impact on compliance with trauma imaging guidelines in the pregnant patient.
abstract: BACKGROUND
  The Royal Melbourne Hospital is a Level 1 adult trauma center, and due to its colocation with The Royal Women's Hospital, it functions as the state's major obstetric trauma center. Obstetric trauma guidelines have been established to facilitate management of pregnant patients, yet adherence to these recommendations has not been evaluated. The aim of this study was to assess compliance with recommended imaging guidelines in obstetric trauma patients.
  
  
  METHODS
  The prospectively collated trauma registry at Royal Melbourne Hospital was used to identify obstetric trauma presentations to the emergency department from January to December 2012. Demographics, mechanism of injury, clinical examination findings, and the use of diagnostic radiology were collected to determine adherence to recommended imaging guidelines.
  
  
  RESULTS
  Of 74 obstetric trauma patients, the most common mechanisms of injury were motor vehicle collisions (81%), assaults (8%), and falls (7%). Despite the mechanism and severity of injury, 29 patients (39%) did not undergo imaging during their initial emergency department assessment. All of the remaining 45 patients (61%) were imaged as part of their assessment; however, plain x-rays were often used to avoid imaging with computed tomography.Of the 32 patients identified with a high-risk mechanism, chest x-ray was used in 84.4%, pelvic x-ray in 28.1%, and computed tomography-angiography in 34.4%. In the high-risk mechanism group, the compliance rate with guidelines was only 18.8% (6 patients had the recommended radiologic assessment).
  
  
  CONCLUSIONS
  Concerns about fetal radiation have resulted in a low compliance rate with recommended trauma guidelines at our institution.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the Department of General Surgical Specialties (R.S., B.N.T., R.J., A.R.S.), and Trauma Service (R.S., B.N.T., R.J., A.R.S.), The Royal Melbourne Hospital; and Department of Surgery (R.S., B.N.T., R.J., A.R.S.), The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Rose
authors.initials: R
authors.lastname: Shakerian
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Thomson
authors.forename: Rodney
authors.initials: R
authors.lastname: Judson
authors.forename: Anita R
authors.initials: AR
authors.lastname: Skandarajah
mesh_terms: D005239:Fear; D005260:Female; D005333:Fetus / Q000528:radiation effects*; D019983:Guideline Adherence; D006801:Humans; D018811:Maternal Exposure / Q000517:prevention & control / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards; D012042:Registries; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000592:standards*; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D014965:X-Rays / Q000009:adverse effects