title: Complete ultrasonography of trauma in screening blunt abdominal trauma patients is equivalent to computed tomographic scanning while reducing radiation exposure and cost.
abstract: BACKGROUND
  Liberal use of computed tomography of the abdomen and pelvis (CTAP) in the screening of blunt abdominal trauma (BAT) has heightened concerns for increased radiation exposure and costs. We sought to demonstrate that in a select group of BAT patients, complete ultrasonography of trauma (CUST) is equivalent to routine CTAP but with significantly decreased radiation and costs.
  
  
  METHODS
  A retrospective analysis of patients screened for BAT from 2000 to 2011 in a Level 1 trauma center was performed. CUST was available from 8:00 AM to 11:00 PM daily, while CTAP was performed thereafter. Decision to perform CTAP or CUST overnight was made by the attending surgeon based on clinical examination. False negatives (FNs) were described as either a negative CUST or CTAP finding, which later required exploratory laparotomy. Medicare rates and previous data were used for the estimation of cost and radiation exposure.
  
  
  RESULTS
  There were 19,128 patients screened for BAT. A total of 12,577 patients (65.8%) initially underwent CUST, and 6,548 (34.2%) underwent CTAP; 11,059 patients (58% of the total BAT patients) avoided a CTAP, yielding an estimated savings of $6.5 million and 188,003 mSv less radiation during the course of the study. Compared with the CTAP group, patients undergoing CUST had lower Injury Severity Score (ISS) (8.1 vs. 9.6), were older (44.7 years vs. 35.2 years), and experienced less traumatic brain injury (61.4% vs. 69.3%) (all with p < 0.002). Mortality was higher in the CUST group (1.8% vs. 1.2%, p = 0.02), but it was insignificant when adjusted for age older than 65 years (1.1% vs. 0.9%, p = 0.23) or head injury (0.6% and 0.3%, p = 0.4). FN CUST and FN CTAP were 0.29% and 0.1%, respectively (p = nonsignificant), with similar mortality (20% vs. 0%, p = 0.44).
  
  
  CONCLUSIONS
  CUST is equivalent to routine CTAP for BAT screening and leads to an average of 42% less radiation exposure and more than $591,000 savings per year.
  
  
  METHODS
  Diagnostic study, level IV; therapeutic/care management study, level IV.
authors.affiliation: From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (Z.A.D., J.D., A.S., R.C.), Department of Surgery, and Department of Radiology (Q.M., G.C.), University of California, San Diego Medical Center, San Diego, California.
authors.forename: Zia A
authors.initials: ZA
authors.lastname: Dehqanzada
authors.forename: Quinn
authors.initials: Q
authors.lastname: Meisinger
authors.forename: Jay
authors.initials: J
authors.lastname: Doucet
authors.forename: Alan
authors.initials: A
authors.lastname: Smith
authors.forename: Giovanna
authors.initials: G
authors.lastname: Casola
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011829:Radiation Dosage; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*