title: Repeated CT scans in trauma transfers: An analysis of indications, radiation dose exposure, and costs.
abstract: OBJECTIVE
  To identify the number of CT scans repeated in acute trauma patients receiving imaging before being referred to a trauma center, to define indications, and to assess radiation doses and costs of repeated CT.
  
  
  METHODS
  This retrospective study included all adult trauma patients transferred from other hospitals to a Level-I trauma center during 2014. Indications for repeated CT scans were categorized into: inadequate CT image data transfer, poor image quality, repetition of head CT after head injury together with completion to whole-body CT (WBCT), and follow-up of injury known from previous CT. Radiation doses from repeated CT were determined; costs were calculated using a nation-wide fee schedule.
  
  
  RESULTS
  Within one year, 85/298 (28.5%) trauma patients were transferred from another hospital because of severe head injury (n=45,53%) and major body trauma (n=23;27%) not manageable in the referring hospital, repatriation from a foreign country (n=14;16.5%), and no ICU-capacity (n=3;3.5%). Of these 85 patients, 74 (87%) had repeated CT in our center because of inadequate CT data transfer (n=29;39%), repetition of head CT with completion to WBCT (n=24;32.5%), and follow-up of known injury (n=21;28.5%). None occurred because of poor image quality. Cumulative dose length product (DLP) and annual costs of potential preventable, repeated CT (inadequate data transfer) was 631mSv (81'304mGy*cm) and 35'233€, respectively.
  
  
  CONCLUSIONS
  A considerable number of transferred trauma patients undergo potentially preventable, repeated CT, adding radiation dose to patients and costs to the health care system.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, Zurich CH-8091, Switzerland. Electronic address: Ricarda.Hinzpeter@usz.ch.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Hinzpeter
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland. Electronic address: Kai.Sprengel@usz.ch.
authors.forename: Kai
authors.initials: K
authors.lastname: Sprengel
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland; Department of General Surgery, Schwarzwald-Baar Klinikum, University of Freiburg, Klinikstr. 11, D-78052 Villingen-Schwenningen, Germany. Electronic address: Guido.Wanner@sbk-vs.de.
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Mainz, Langenbeckstr. 1, D-55131 Mainz, Germany. Electronic address: peter.mildenberger@unimedizin-mainz.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Mildenberger
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, Zurich CH-8091, Switzerland. Electronic address: hatem.alkadhi@usz.ch.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D006259:Craniocerebral Trauma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data*
keywords: Health care costs; Imaging; Radiation exposure; Trauma