title: The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study.
abstract: BACKGROUND
  Defensive medicine is estimated to cost the United States $210 billion annually. Trauma surgeons are at risk of practicing defensive medicine in the form of reflexively ordering computed tomography (CT) scans. The aim of this study is to quantify the monetary impact and radiation exposure related to the radiographic workup of trauma patients.
  
  
  METHODS
  We conducted a prospective, observational study involving 295 trauma patients at Level I trauma center. Physicians were surveyed regarding specific CT scans ordered, likelihood of significant injuries found on scans, and which scans would have been ordered in a hypothetical, litigation-free environment.
  
  
  RESULTS
  Four hundred sixteen of 1,097 CT scans (38%) were ordered out of defensive purposes. Nine CT scans (2.2%) that would not have been ordered resulted in a change in management. Defensively ordered CT scans resulted in nearly $120,000 in excess charges and 8.8 mSv of unnecessary radiation per patient.
  
  
  CONCLUSIONS
  Defensively ordered CT scan in the workup of trauma patients is a prevalent and costly practice that exposes patients to potentially unnecessary and harmful radiation.
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA; Department of Surgery, University of Utah and Affiliated Hospitals, 50 North Medical Drive, Salt Lake City, UT 84112, USA. Electronic address: Jennwood.chen@hsc.utah.edu.
authors.forename: Jennwood
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Majercik
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Connor
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Morris
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Gardner
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Scully
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Wilson
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Dickerson
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: White
authors.affiliation: Department of Surgery, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Dillon
mesh_terms: D003675:Defensive Medicine / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
keywords: Defensive medicine; Healthcare costs; Healthcare reform; Radiation exposure; Trauma surgery