ARRS: Trauma CT based on clinical findings halves CT utilization, dose + costs

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 - Emergency Department

The standard trauma protocol of ordering a nonfocused CT study on transferred patients who underwent a focused exam at an outside institution is unnecessary and leads to overutilization, according to an April 15 presentation at the annual meeting of the American Roentgen Ray Society in Washington, D.C. Instead, researchers recommended an imaging strategy informed by patient history and physical findings.

Although conventional protocols suggest an extensive, nonfocused CT study that includes a CT exam of the head, cervical spine, thoracic spine, lumbar spine, chest, abdomen and pelvis for transferred trauma patients, researchers hypothesized that these additional studies add minimal clinical information compared to focused exams.

Thus, Matthew Heller, MD, of University of Pittsburgh Medical Center (UPMC), and colleagues aimed to evaluate the utility of additional CT exams and conducted a chart review of 100 trauma patients transferred from outside facilities.

A total of 68 patients transferred to the UPMC trauma center underwent additional CT exams. Studies were evaluated by one of eight emergency radiologists to determine if the nonfocused exams showed additional findings not detected by the initial CT at the outside facility.

The nonfocused protocol generated 313 negative studies in 63 patients. Five patients had unexpected findings, including three with fractured ribs; however, these diagnoses did not change clinical management.

“Scanning patients according to the standard trauma protocol generated hundreds of CT examinations which did not impact the patient's care," Heller said in a press release. “On average, we found that the standard trauma protocol generated approximately 5 CT examinations per patient that were either negative or not clinically significant."

Heller and colleagues estimated that CT utilization, imaging costs and radiation dose can be reduced by at least 50 percent if the standard protocol is replaced by imaging dictated by the patient's history and physical examination findings.