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Thoracoabdominal computed tomography in trauma patients: a cost-consequences analysis
Raoul van Vugt1, Digna R Kool2, Monique Brink2
1Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Trauma Monthly
|October 23, 2014
Summary
Rush CT offers the lowest cost and comparable diagnostic certainty and radiation dose to routine CT for blunt trauma patients. Selective CT reduces radiation but increases cost and misses injuries.
Area of Science:
- Medical imaging
- Trauma surgery
- Health economics
Background:
- Computed tomography (CT) is increasingly utilized for initial blunt trauma patient evaluation.
- Cost-effectiveness of CT in trauma care requires careful assessment.
Purpose of the Study:
- To evaluate the cost-consequences of different diagnostic algorithms using thoracoabdominal CT in the primary assessment of adult high-energy blunt trauma patients.
Main Methods:
- Comparison of three algorithms: immediate CT (rush CT), CT after limited conventional work-up (routine CT), and selective CT.
- Retrospective derivation of injury detection/miss rates.
- Analysis of radiation exposure and micro-costing.
Main Results:
- Rush and routine CT detected 99.1% of thoracoabdominal injuries.
- Selective CT missed diagnoses in 11% of patients, altering treatment in 4.8%.
- Rush CT: €2676, 26.40 mSv; Routine CT: €2815, 26.40 mSv; Selective CT: €2771, 23.23 mSv.
Conclusions:
- Rush CT presents the lowest cost, with diagnostic certainty and radiation dose comparable to routine CT.
- Selective CT lowers radiation dose but incurs higher costs and slightly reduced diagnostic certainty.
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