Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients...

Many clinicians order focused computed tomography (CT) examinations for trauma patients based on history and physical examinations. Trauma patients transferred to our level I trauma center undergo an extensive, nonfocused standard trauma CT protocol. We hypothesize that the use of the standard trauma CT protocol does not contribute significant clinical information for patient care when compared with CT examinations based on history and physical examination. We aim to quantify the utility of the additional CT examinations required by our institution's trauma protocol compared with emergent CT examinations dictated by the patient's history and physical examination findings. In this IRB-approved study, we retrospectively evaluated 132 trauma patients transferred to our center who underwent additional CT examinations as determined by fulfillment of our institution's standard trauma CT protocol. The emergency radiologist evaluated the CT examinations acquired after the patient's transfer to determine if there were any additional acute findings that were identified on these additional examinations compared with the initial assessment undertaken at the outside institution. A total of 101 patients transferred to our trauma center met inclusion criteria. The majority of these patients sustained minor trauma. The standard trauma protocol generated 474 negative CT examinations in 101 patients. In seven patients, there were unexpected acute findings. However, these unexpected acute findings did not change clinical management in any of the patients. After initial evaluation, the acquisition of additional nonfocused CT examinations based on the standard trauma CT protocol provides little useful clinical information in patients who are transferred for minor trauma. Rather, CT utilization should be based on clinical findings. Replacement of standard trauma CT protocol with focused CT examinations in trauma patients is a way to curtail overutilization, thereby decreasing health care cost and the amount of patient radiation exposure.