Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients.
BACKGROUND
During the initial assessment of patients with potential severe injuries, radiological examinations are performed in order to rapidly diagnose clinically relevant injuries. Previous studies have shown that performing these examinations routinely is not always necessary and that trauma patients are exposed to substantial radiation doses. The aim of this study was to assess the amount and findings of radiological examinations during the initial assessment of trauma patients and to determine the radiation doses to which these patients are exposed to.


METHODS
We analyzed the 1124 patients included in a randomized trial. All radiological examinations during the initial assessment (i.e., primary and secondary survey) were assessed. The examination results were categorized as positive findings (i.e., (suspicion for) traumatic injury) and normal findings. The effective radiation doses for the examinations were calculated separately for each patient.


RESULTS
Eight hundred and three patients were male (71 %), median age was 38 years, and 1079 patients sustained blunt trauma (96 %). During initial assessment, almost 3900 X-rays were performed, of which 25.4 % showed positive findings. FAST of the abdomen was performed in 989 patients (88 %), with positive findings in 10.6 %. Additional CT scanning of specific body regions was performed 1890 times in 813 patients (72.1 %), of which approximately 43.4 % revealed positive findings. Hemodynamically stable patients showed more normal findings on the radiographic studies than unstable patients. The mean radiation doses for the total population was 8.46 mSv (±7.7) and for polytraumatized patients (ISS ≥ 16) 14.3 mSv (±9.5).


CONCLUSIONS
Radiological diagnostics during initial assessment of trauma patients show a high rate of normal findings in our trauma system. The radiation doses to which trauma patients are exposed are considerable. Considering that the majority of the injured patients are hemodynamically stable, we suggest more selective use of X-ray and CT scanning.
Department of Trauma Surgery, VU University Medical Centre, Room 7F-002, PO Box 7057, NL - 1007 MB, Amsterdam, The Netherlands. gf.giannakopoulos@gmail.com.
G F
GF
Giannakopoulos
Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
T P
TP
Saltzherr
Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
L F M
LF
Beenen
Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.|Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands.
G J
GJ
Streekstra
Department of Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands.
J B
JB
Reitsma
Department of Trauma Surgery, VU University Medical Centre, Room 7F-002, PO Box 7057, NL - 1007 MB, Amsterdam, The Netherlands.
F W
FW
Bloemers
Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
J C
JC
Goslings
Department of Trauma Surgery, VU University Medical Centre, Room 7F-002, PO Box 7057, NL - 1007 MB, Amsterdam, The Netherlands.
F C
FC
Bakker
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069079:Radiation Exposure; D011859:Radiography; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
Diagnosis; Overuse; Radiology; Trauma
J Trauma. 2007 Jan;62(1):151-6
17215747
J Trauma. 2006 Sep;61(3):607-9; discussion 609-10
16966995
Br J Surg. 2012 Jan;99 Suppl 1:105-13
22441863
PLoS One. 2013 Jul 24;8(7):e68880
23894365
Ann Emerg Med. 1994 Oct;24(4):685-90
8092595
Eur Radiol. 2010 Apr;20(4):818-28
19760233
J Trauma. 1992 Sep;33(3):413-6
1404511
Arch Orthop Trauma Surg. 2004 Mar;124(2):123-8
14745568
J Trauma. 2007 Jan;62(1):74-8; discussion 78-9
17215736
J Trauma. 2004 Sep;57(3):510-4
15454795
J Trauma. 2010 May;68(5):1213-7
20016389
Emerg Radiol. 2006 Oct;13(1):25-30
16900352
J Trauma. 2008 Nov;65(5):1114-6
19001983
Eur J Med Res. 2010 May 18;15(5):185-95
20562057
J Trauma. 2007 Mar;62(3):631-5
17414339
JAMA. 2001 Oct 17;286(15):1841-8
11597285
J Trauma. 1992 Sep;33(3):408-12
1404510
Can J Surg. 2009 Apr;52(2):147-52
19399211
Radiology. 2008 Jul;248(1):254-63
18566177
Arch Surg. 2001 Jul;136(7):752-6
11448384
Surgery. 2010 Oct;148(4):695-700; discussion 700-1
20800865
J Trauma. 2011 Jun;70(6):1366-70
20962680
Crit Care Med. 2009 Apr;37(4):1336-40
19242327
JAMA. 2010 Oct 6;304(13):1465-71
20924012
World J Surg. 2014 Apr;38(4):795-802
24170153
J Am Coll Surg. 2002 Feb;194(2):121-5
11848627
N Engl J Med. 2000 Jul 13;343 (2):94-9
10891516