Utilization of Computed Tomography in Temporal Bone Fractures at a Large Level I Trauma Center

Area of Science:

• Radiology
• Neurosurgery
• Otolaryngology

Background:

• Temporal bone fractures require accurate diagnosis to prevent complications.
• Dedicated temporal bone CT scans are often used but may not be necessary for all patients.

Purpose of the Study:

• To determine if trauma pan-scan CT is adequate for evaluating temporal bone fractures in certain patients.
• To assess the cost-effectiveness of avoiding dedicated temporal bone CT in lower-risk individuals.

Main Methods:

• Retrospective chart review of 180 adult patients with temporal bone fractures.
• Risk stratification into lower- and higher-risk groups based on imaging and physical exam.
• Comparison of trauma pan-scan CT and dedicated temporal bone CT findings for five critical anatomic structures.

Main Results:

• In the lower-risk group (120 patients), trauma pan-scan CT showed high negative predictive values for fractures involving critical structures (e.g., otic capsule 1.000, facial nerve canal 1.000).
• Estimated annual out-of-pocket costs for dedicated temporal bone CT in the lower-risk group were approximately $34,000.

Conclusions:

• Trauma pan-scan CT can be sufficient for identifying temporal bone fracture involvement in lower-risk patients.
• Reducing dedicated temporal bone CT imaging can decrease radiation exposure and radiology department workload.