Evaluating our progress with trauma transfer imaging: repeat CT scans, incomplete imaging, and delayed definitive care.

Abstract

Many trauma patients present at non-trauma centers and require transfer. CT imaging obtained at the initial hospital (IH) may lead to delays in definitive trauma care, and previous studies have shown imaging is often repeated at the trauma center (TC). A retrospective review was performed of all tier 1 trauma patients transferred to our TC between May 2018 and April 2019. Patients that did and did not undergo CT imaging at the IH were compared (n = 147). Of those with IH CT imaging (n = 68), we identified 4 imaging "inadequacies": (1) repeat CT scans: CT scan of the same body region performed at IH and at TC; (2) C-spine inadequacies: severely injured patients who underwent head CT without a C-spine CT; (3) incomplete chest-abdomen-pelvis (CAP): patients with partial CAP CT imaging at IH that underwent an additional portion of CAP imaging at TC; (4) CAP CT without IV contrast. IH time was significantly prolonged when CT imaging was obtained. Of those that had IH imaging, 13 patients (19%) required repeat CT, ten (15%) had a C-spine inadequacy, 11 (16%) had incomplete CAP, and 28 (41%) had one or more inadequacy. Patients with any inadequacy underwent more CT imaging. Most patients (76%) with imaging at the IH returned to the CT scan at the TC. In severely injured trauma patients transferred to our TC, we identified many continuing issues with IH CT imaging. The imaging inadequacies detailed above lead to delays in definitive care and subject patients to increased radiation.