Use of computed tomography in the setting of a tiered trauma team activation system in Australia

This study aims to describe the patterns in the use of computed tomography (CT) imaging in the setting of a two-tiered trauma team activation system without a mandatory whole-body ("panscan") trauma CT protocol. A prospective study was conducted at a single inner city major trauma centre in Sydney, Australia. Adult patients presenting to the emergency department requiring a trauma team activation were studied over 1 year. Patients in the trauma consult group met predetermined criteria for mechanism of injury without vital sign abnormalities or clinical evidence of major injury. Full trauma team response patients were those who had abnormal predetermined vital signs or evidence of major injury on initial assessment. The outcomes measured were severe injury, multiregion injury and positive CT scans. Of the patients, 1,058 were studied of whom 63 % had at least one CT scan performed. The most common CT studies were CT brain in combination with cervical spines (23 %) and isolated abdominal CT scans (17 %). The full trauma response group was associated with significantly higher rates of severe injury (34 versus 8 %, p<0.001), multiregion injury (13 versus 3 %, p<0.001), need for operative intervention (37 versus 15 %, p<0.001) and in-hospital mortality (4 versus 0.7 %, p<0.001). This group was also associated with significantly higher odds of whole-body CT use [odds ratio (OR) 5.6, 95 % confidence interval (CI) 3.6-8.8, p<0.001] and higher odds of positive CT brain studies compared to the trauma consult group (OR 2.6, 95 % CI 1.7-4.1, p<0.001). A tiered trauma team activation criteria in combination with trauma team assessment may be used to triage patients requiring CT without the need for mandatory CT protocols based on mechanism alone.