Evaluating our progress with trauma transfer imaging: repeat CT scans, incomplete imaging, and delayed definitive...

Area of Science:

• Trauma Care
• Radiology
• Medical Imaging

Background:

• Many severely injured trauma patients are initially treated at non-trauma centers before transfer.
• Computed tomography (CT) imaging at the initial hospital (IH) may delay definitive care at the trauma center (TC).
• Previous studies suggest repeat imaging is common when patients transfer between facilities.

Purpose of the Study:

• To evaluate the frequency and types of CT imaging inadequacies in transferred trauma patients.
• To determine the impact of IH CT imaging on patient care and resource utilization.

Main Methods:

• Retrospective review of tier 1 trauma patients transferred to a TC (May 2018-April 2019).
• Comparison of patients who underwent CT at IH versus those who did not.
• Identification and categorization of CT imaging "inadequacies" at IH: repeat scans, C-spine protocol omissions, incomplete body imaging, and lack of IV contrast.

Main Results:

• Initial hospital (IH) time was significantly prolonged for patients receiving CT imaging.
• Of patients with IH CT, 41% had at least one inadequacy.
• Common inadequacies included repeat CT scans (19%), C-spine protocol omissions (15%), and incomplete chest-abdomen-pelvis (CAP) scans (16%).
• Most patients (76%) with IH imaging underwent repeat CT scans at the TC.

Conclusions:

• Significant issues persist with the quality and utility of IH CT imaging for transferred trauma patients.
• CT imaging inadequacies contribute to delays in definitive trauma care and increase patient radiation exposure.
• Standardization of imaging protocols at non-trauma centers is needed to improve care for severely injured patients.