Computed Tomography in Trauma Patients Accepted in Transfer:

Missed Injuries and Rationale for Repeat Imaging. Can we do Better?

Abstract

Introduction. Computed tomography scans often are repeated on
trauma patient transfers, leading to increased radiation exposure,
resource utilization, and costs. This study examined the incidence
of repeated computed tomography scans (RCT) in trauma patient
transfers before and after software upgrades, physician education,
and encouragement to reduce RCT.
Methods.xThe number of RCTs at an American College of Surgeons
Committee on Trauma verified level 1 trauma center was measured.
The trauma team was educated and encouraged to use the computed
tomography scans received with transfer trauma patients as per
study protocol. All available images were reviewed and reasons for a
RCT when ordered were recorded and categorized. Impact of system
improvements and education on subsequent RCT were evaluated.
Results. A RCT was done on 47.2% (n = 76) of patients throughout
the study period. Unacceptable image quality and possible missed
diagnoses were the most commonly reported reasons for a RCT. Preventable
reasons for a RCT (attending refusal to read outside films,
incompatible software, and physician preference) decreased from
25.8 to 14.3% over the study periods.
Conclusions. The volume of unnecessary RCT can be reduced primarily
through software updates and physician education, thereby
decreasing radiation exposure, patient cost, and inefficiencies in hospital
resource usage. Kans J Med 2019;12(1):7-10.