Repeat computed tomography scans among inter-facility transferred major trauma patients in Oklahoma, 2009-2015

Computed tomography (CT) scans play a vital role in the diagnosis and evaluation of trauma patients. Repeat CT scans occurred often among transferred trauma patients. The objective was to describe CT use and identify patient- and hospital-level factors associated with repeat CT scans among inter-facility transferred major trauma patients.

A retrospective cohort study was conducted using data extracted from the Oklahoma State Trauma Registry between 2009 and 2015. Both bivariate and multivariate analyses were employed to assess the factors associated with repeat CT scans.

During the 7-year study period, 8678 major trauma patients were transferred between acute-care hospitals in Oklahoma. Among them, 4311 patients had at least one repeat CT scan. Head CT scans were the most commonly performed as well as repeated. Bivariate analysis showed that differences in repeat CT scans were associated with age, injury type, injury severity score, head injury severity, revised trauma score, payer source, transport mode to referring facilities, and facility levels at the 5% level. Multivariate analysis showed the odds of repeat CT scans were higher for adult and geriatric patients, patients with blunt injuries, severely injured patients, patients with severe head injuries, patients with a good revised trauma score, patients discharged alive, and mode to referring facilities.

Our study demonstrated that inter-facility transfers within an organized rural trauma system often underwent repeat CT scans. The large proportion of patients with multiple and repeated CT scans should underline the importance of trauma systems evaluating the necessity of CT scans, image-sharing capability, and obtaining appropriate scans in order to optimize use. Overall, reducing unnecessary CT scans should be an essential part of trauma care quality improvement efforts.