Abstract
BackgroundRecurrent CT imaging is believed to significantly increase lifetime malignancy risk. We previously reported that high acuity, admitted trauma patients who received a whole-body CT in the emergency department (ED) had a history of prior CT imaging in 14% of cases. The primary objective of this study was to determine the CT imaging history for trauma patients who received a whole-body CT but were ultimately deemed safe for discharge directly home from the ED.MethodsThis was a retrospective cohort study conducted at an academic ED. All trauma patients who were discharged directly home from the ED after whole-body CT were analyzed. The decision to utilize whole-body CT was at the discretion of the caring physician during the study period. Clinical data for the most recent trauma visit was recorded in a structured fashion on a standardized data collection instrument utilizing the hospital system electronic medical record (EMR). Subsequently, study investigators reviewed a shared, electronic radiological archive for the 6-hospital system to evaluate prior CT exposure for each patient.Results165 patients were in the study group. The mean age of the study group was 39+/− 16 years old, 40% were female and 64% were Hispanic. The most common mechanism of injury in our study group was motor vehicle crash (MVC) (66%). In our study group, 25% had at least one prior CT. The most common prior studies performed were: CT abdomen/pelvis (13%), CT head (9.1%), CT face (6.7%), and CT chest (1.8%). Within a multivariate logistic regression model we found that the large majority of patient characteristics and mechanisms of injury were not associated with a positive prior CT imaging history.ConclusionWe found a positive history for prior CT for 25% of trauma patients who received whole-body CT scan but were discharged from the ED to home.
Highlights
Recurrent Cat Scan (CT) imaging is believed to significantly increase lifetime malignancy risk
One-fourth (25%; 41/165, 95% CI = 19–32%) had at least one prior CT
The prior studies performed in order of frequency were: CT abdomen/ pelvis 13% (21/165), CT head 9.1% (15/165), CT face 6.7% (11/165), CT cervical spine 5.5% (9/165), CT limb 4.2% (7/165), CT thoracic spine 3%(5/165), CT lumbar spine 3%(5/165), CT neck 1.8% (3/165), and CT chest 1.8% (3/165)
Summary
Recurrent CT imaging is believed to significantly increase lifetime malignancy risk. We previously reported that high acuity, admitted trauma patients who received a whole-body CT in the emergency department (ED) had a history of prior CT imaging in 14% of cases. Rosen described that CT is beneficial to the emergency medicine physician by increasing the certainty of diagnosis within a short period of time and significantly decreasing the need for surgical exploration [1]. In light of these benefits, CT use in the ED increased from 2 million studies (1980) to 72 million (2007) [2]. From 1998 to 2007 there was a national 3-fold increase in the use of CT scans in the ED for injury-related conditions [4] Such an increase is undoubtedly due to the potential for such imaging to Matthews et al BMC Emergency Medicine (2018) 18:34 reduce the risk of missed injury. Several investigators have reported that whole-body (brain, c-spine, trunk) CT frequently identifies unexpected findings and can lead to a change of treatment as high as 33% of patients [5,6,7]
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