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Implementation of Institutional Triaging Algorithms Decreases Head and Neck MDCT Use in Blunt Trauma
Chad W Farris1, Arthur Baghdanian1, Courtney Takahashi1
1From the Departments of Radiology (C.W.F., A.B., E.K.S., O.S., A. Rai, A.Z.M.), Neurology (C.T.), and Surgery (T.B.), Boston Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; and Departments of Radiology (C.W.F., A.B., E.K.S., O.S., M.P., H.B., A. Rai, D.A., H.K., A. Ravilla, A.Z.M.), Neurology (C.T.), and Surgery (T.B.), Boston University School of Medicine, Boston, Mass.
Implementing clinical triaging algorithms reduced multidetector CT (MDCT) use for head and neck blunt trauma patients. This approach decreased head and cervical spine MDCT scans without negatively impacting patient outcomes.
Area of Science:
- Radiology and Imaging
- Trauma Surgery
- Health Services Research
Background:
- Multidetector CT (MDCT) is crucial for diagnosing head and neck (HN) blunt trauma (BT).
- Overutilization of MDCT necessitates strategies for appropriate patient selection to optimize workflow.
- Clinical triaging algorithms may help streamline MDCT use in trauma patients.
Purpose of the Study:
- To evaluate the impact of clinical triaging algorithms on MDCT utilization in HN BT patients.
- To assess if algorithm implementation affects the rates of head, cervical spine, and HN MDCT.
Main Methods:
- Retrospective study of 8999 adult BT patients (2007-2013), divided into pre- and post-algorithm implementation groups.
- Review of trauma registry and imaging reports to determine MDCT use (head, cervical spine, HN angiography) and outcomes.
- Analysis included Injury Severity Score, LOS, ICULOS, and mortality.
Main Results:
- Post-algorithm implementation showed a significant decrease in MDCT of the head (64.2% to 55.8%) and cervical spine (60.5% to 49.4%).
- MDCT angiography of the HN showed no significant change in utilization rates.
- No significant differences were observed in length of stay, ICU stay, or mortality between groups.
Conclusions:
- Clinical triaging algorithms effectively reduced the use of head and cervical spine MDCT in blunt trauma patients.
- The implementation of these algorithms did not lead to an increase in adverse patient outcomes.
- This suggests a successful strategy for optimizing MDCT resource allocation in trauma care.
