Additional and repeated computed tomography in interfacility trauma transfers: Room for standardization

• Published in: Surgery 2018-10, Vol.164 (4), p.872-878
• Main Authors: Bracco, David, Deckelbaum, Dan, Artho, Giovanni, Khwaja, Kosar, Mulder, David S., Gruska, Jeremy, Razek, Tarek
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Hospitals - standards; Humans; Male; Middle Aged; Patient Transfer - standards; Reference Standards; Tomography, X-Ray Computed - standards; Trauma Centers - standards; Urban Population; Wounds and Injuries - diagnostic imaging; Wounds and Injuries - therapy
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2018.07.007

Despite the recommendations of the Advanced Trauma Life Support course of the American College of Surgeons, patients undergo computed tomography (CT) in local hospitals before transfer to a trauma center. The problem of repeat CTs caused by technical and protocol issues is ongoing. The objective is to measure the importance of repeat CTs and CTs involving other body regions. All secondary transfers to our level 1 facility with CT at the local hospital over 9 years were reviewed. Patients were considered to have had a repeat CT if the same body region or an another body region was scanned as a part of the initial assessment but not for reasons of clinical follow-up. Of 6,292 patients received from local hospitals, 685 (12%) had undergone 1097 CT scans at the local hospitals. Patients being scanned in local hospitals were sicker (injury severity score: 21 vs 13) and required more intensive care unit admissions (38% vs 29%) and more ventilation (32% vs 22%). Thirty-nine percent of CTs were repeated, and 55% of these patients required imaging of another body part. Repeat and additional images remain a major issue in trauma transfers. Improvement requires standardization of CT protocols and change in the approach of local hospitals from “finding and requiring need level 1 trauma center” to “not missing any injuries.”