Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome?

Autor: van den Hout WJ; Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands., van der Wilden GM; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. gmvanderwilden@alrijne.nl.; Division of Surgery, Department of Traumatology, Alrijne Hospital, Simon, Smitweg 1, 2353 GA, Leiderdorp, The Netherlands. gmvanderwilden@alrijne.nl., Boot F; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands., Idenburg FJ; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands., Rhemrev SJ; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands., Hoencamp R; Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.; Division of Surgery, Department of Traumatology, Alrijne Hospital, Simon, Smitweg 1, 2353 GA, Leiderdorp, The Netherlands.; Ministry of Defense, The Hague, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2018 Aug; Vol. 44 (4), pp. 607-614. Date of Electronic Publication: 2017 Sep 04.
DOI: 10.1007/s00068-017-0831-5
Abstrakt: Background: To be a level I trauma center in the Netherlands a computed tomography (CT) scanner in the emergency department (ED) is considered desirable, as it is presumed that this optimizes the diagnostic process and that therapy can be directed based on these findings. Aim of this study was to assess the effects of implementing a CT scanner in the ED on outcomes in patients with penetrating injuries.
Methods: In this retrospective descriptive study, patients with penetrating injuries (shot and/or stab wounds), presented between 2000 and 2014 were analysed using the hospital's electronic database, and data from the West Netherlands trauma registry and the financial department.
Results: 405 patients were included: performing a CT scan upon arrival increased significantly from 26.7 to 67.0% (p = 0.00) after implementation of a CT scanner in the ED, with the mean cost of a CT being 96.85 euros. Overall mortality decreased from 6.9 to 3.7%, although not statistically significant. Intensive care unit admission (ICU-admission) and median hospital length of stay (H-LOS) decreased from 30.9 to 24.5% resp. 3.2 to 1.8 days (p ≤ 0.05). Overall mortality, adjusted for injury severity score (ISS), revised trauma score (RTS), and types of injuries, did not change significantly.
Conclusion: Patients with penetrating injuries more often received a CT scan on admission after implementation of a CT scanner in the ED. Early CT scanning is useful since it significantly reduces ICU-admissions and decreases H-LOS. It is a cheap and non-invasive diagnostic tool with significant clinical impact, resulting in directed treatment, and improvement of outcomes.
Databáze: MEDLINE
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