To Scan or Not to Scan: Evaluating CT Discrepancies in Trauma Interfacility Transfers

BackgroundDespite existing recommendations, trauma patients often undergo computed tomography (CT) imaging at referring hospitals (RH) prior to transferring to Level 1 trauma centers (L1TC). Inaccurate CT scan interpretations from RH can lead to diagnostic uncertainty. Therefore, this study sought to determine the frequency and type of CT scan interpretation discrepancies in patients transferred to a L1TC, evaluate the impact of discrepant reads on patient management, and identify patient risk factors associated with these discrepancies.MethodsA retrospective study was performed on 348 trauma patients transferred from RH to a L1TC between January and June 2024. 938 RH CT scans were reread by board-certified radiologists to identify discrepancies. Discrepancies included missed and over diagnosed injuries and were classified as requiring major or minor management changes. Multivariate logistic regression identified patient risk factors for discrepancies.ResultsCT interpretation discrepancies occurred in 24.4% of patients, with 69.4% having at least one missed injury and 38.8% having at least one over diagnosed injury. Inaccuracy rates were highest among chest and abdomen/pelvis CTs (31.9%). Major management changes were present in 64.3% of all discrepancies, with the most frequent being new consultations (75.9%), additional imaging (68.5%), and ICU admission (61.1%). Younger age was predictive of discrepancies (P < .05).ConclusionDiscrepancies in CT scan interpretations from RH to L1TC remain common and frequently have major implications for patient care. Findings support guidelines to reduce unnecessary imaging pre-transfer and highlight the burden on L1TCs to resolve diagnostic uncertainty following interfacility transfer.