Additional and repeated computed tomography in interfacility trauma transfers: Room for standardization.

Area of Science:

• Trauma care
• Radiology
• Medical imaging

Background:

• Advanced Trauma Life Support (ATLS) guidelines are not consistently followed.
• Patients receive computed tomography (CT) scans at local hospitals before transfer to trauma centers.
• Repeat CT scans due to technical or protocol issues are a persistent problem.

Purpose of the Study:

• To quantify the incidence and impact of repeat CT scans in trauma transfers.
• To assess the frequency of CT scans involving additional body regions.
• To identify areas for improvement in trauma imaging protocols.

Main Methods:

• A retrospective review of 6,292 patients transferred to a level 1 trauma facility over 9 years.
• Analysis of CT scans performed at local hospitals prior to transfer.
• Definition of repeat CT as scanning the same or a different body region for initial assessment.

Main Results:

• 12% of transferred patients (685/6,292) had undergone 1097 CT scans locally.
• Patients scanned locally had higher injury severity scores (21 vs 13) and required more intensive care.
• 39% of local CT scans were repeated, and 55% of these patients needed imaging of another body part.

Conclusions:

• Repeat and additional CT imaging represent a significant challenge in trauma patient transfers.
• Standardization of CT protocols across local hospitals is essential.
• A shift in local hospital approach from "finding and requiring need" to "not missing injuries" is necessary.