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Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate
Wayne S Lee1, Nancy A Parks, Arturo Garcia
1From the Department of Surgery, University of California San Francisco, East Bay Oakland, California.
Background:
Pan computed tomography (PCT) of the head, cervical spine, chest, abdomen, and pelvis is a valuable approach for rapid evaluation of severely injured blunt trauma patients. A PCT strategy has also been applied for the evaluation of patients with lower injury severity; however, the cost-utility of this approach is undetermined. The advantage of rapidly identifying all injuries via PCT must be weighed against the risk of radiation-induced cancer (RIC). Our objective was to compare the cost-utility of PCT with selective computed tomography (SCT) in the management of blunt trauma patients with low injury severity.
Methods:
A Markov model-based, cost-utility analysis of a hypothetical cohort of hemodynamically stable, 30-year-old males evaluated in a trauma center after motor vehicle crash was used. CT scans are performed based on the mechanism of injury. The analysis compared PCT with SCT over a 1-year time frame with an analytic horizon over the lifespan of the patients. The possible outcomes, utilities of health states, and health care costs including RIC were derived from the published medical literature and public data. Costs were measured in US 2010 dollars, and incremental effectiveness was measured in quality-adjusted life-years (QALYs) with 3% annual discounted rates. Multiway sensitivity analyses were performed on all variables.
Results:
The total cost for blunt trauma patients undergoing PCT was $15,682 versus $17,673 for SCT. There was no difference in QALYs between the two populations (26.42 vs. 26.40). However, there was a cost savings of $75 per QALY for patients receiving PCT versus SCT ($594 per QALY vs. $669 per QALY).
Conclusion:
PCT enables surgeons to identify and rule out injuries promptly, thereby reducing the need for inpatient observation. The risk of RIC is low following a single PCT. This cost-utility analysis finds PCT based on mechanism to be a cost-effective use of resources.
Level Of Evidence:
Economic and value-based evaluations, level II.
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