title: Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers.
abstract: BACKGROUND
  Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities.
  
  
  METHODS
  A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury (direct group), transfer from another medical facility (transfer group), computed tomographic scans received, dose-length product, CED of radiation, and injury severity score. A diagnostic imaging physicist then calculated the estimated CED each subject received based on the dose-length product of each computed tomographic scan.
  
  
  RESULTS
  A total of 300 patients were analyzed, with 150 patients in the direct group and 150 patients in the transfer group. Both groups were similar in age and sex. Patients in the transfer group received a significantly greater CED of radiation compared with the direct group (mean, 37.6 mSv vs 28 mSv; P=.001). The radiation received in the direct group correlates with a lifetime attributable risk (LAR) of 1 in 357 compared with the transfer group with an increase in LAR to 1 in 266.
  
  
  CONCLUSIONS
  Patients transferred to our facility received a 34% increase in ionizing radiation compared with patients brought directly from the injury scene. This increased dose of ionizing radiation contributes to the LAR of cancer and needs to be considered before repeating imaging studies.
  
  
  METHODS
  III.
authors.affiliation: Department of Emergency Medicine, United States Army, San Antonio Military Medical Center, San Antonio, TX. Electronic address: kerri.a.vanarnem.mil@mail.mil.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Van Arnem
authors.affiliation: Department of Emergency Medicine, United States Air Force, San Antonio Military Medical Center, San Antonio, TX. Electronic address: david.supinski@us.af.mil.
authors.forename: David P
authors.initials: DP
authors.lastname: Supinski
authors.affiliation: Department of Radiology, San Antonio Military Medical Center, San Antonio, TX. Electronic address: jonathan.e.tucker.civ@mail.mil.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Tucker
authors.affiliation: Department of Emergency Medicine, USUHS, San Antonio Military Medical Center, San Antonio, TX. Electronic address: smvarney@gmail.com.
authors.forename: Shawn
authors.initials: S
authors.lastname: Varney
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010360:Patient Transfer; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014481:United States; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*