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J Surg Res. 2017 Jun 1;213:6-15. doi: 10.1016/j.jss.2017.02.015. Epub 2017 Feb 24.

Variability in CT imaging of blunt trauma among ED physicians, surgical residents, and trauma surgeons.

Author information

1
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York.
2
Department of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, New York.
3
Department of Surgery, Weill Cornell Medicine, New York, New York; Department of Medicine, Weill Cornell Medicine, New York, New York.
4
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York; Department of Surgery, University of California at Irvine Medical Center, Orange, California. Electronic address: sschubl@gmail.com.

Abstract

BACKGROUND:

Trauma triage decisions can be influenced by both knowledge and experience. Consequently, there may be substantial variability in computed tomography (CT) scans desired by emergency medicine physicians, surgical chief residents, and attending trauma surgeons. We quantified this difference and studied the effects of each group's decisions on missed injuries, cost, and radiation exposure.

METHODS:

All blunt trauma activations at an urban level 1 trauma center were studied over a 6-mo period. Three months into the study, a pan-scan protocol was introduced. Prior to CT imaging, providers separately completed a survey that asked which CT scans were desired for each patient. Based on the completed surveys, hypothetical missed injuries, radiation exposure, and cost were determined.

RESULTS:

The variability in the number of CT scans desired by each of the three providers and the resulting cost and radiation exposure were not statistically significant. Substantial variability was predominantly seen in the indications for the desired scans, with the difference between proportions ranging from 3.1%-68.7%. Agreement among the three providers was highest for head and c-spine scans (80%-100%) and lowest for maxillary face (57%-80%) and chest scans (52%-74%). Overall, the missed injury rate was similar for all the providers; chief residents missed significantly more major injuries than trauma attendings during the pan-scan period (P = 0.03).

CONCLUSIONS:

Trauma training and level of training did not have a substantial effect on radiological decisions during the initial trauma assessment. This study sheds light on the growing uniformity among providers with regard to medical decision-making in the initial work-up of trauma.

KEYWORDS:

Computed tomography; Emergency radiology; Trauma radiology; Trauma triage; Triage decision-making

PMID:
28601333
DOI:
10.1016/j.jss.2017.02.015
[Indexed for MEDLINE]

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