The Utility of Additional Imaging in Trauma Consults with Mild to Moderate Injury
| Autor: | Andrew D. Benson, Michael S. Nussbaum, Bryan R. Collier, Mark E. Hamill, Daniel W. Freeman, Daniel I Lollar, Katie M Love, Andrew L. Plaster, Emily R. Faulks |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry Trauma center 030208 emergency & critical care medicine General Medicine Limiting 030230 surgery 03 medical and health sciences 0302 clinical medicine Treatment plan Chart review Emergency medicine medicine Injury Severity Score Clinical significance Ct imaging business |
| Zdroj: | The American Surgeon. 84:1825-1831 |
| ISSN: | 1555-9823 0003-1348 |
| DOI: | 10.1177/000313481808401143 |
| Popis: | Limiting CT imaging in the ED has gained interest recently. After initial trauma workup for consultations in the ED, additional CT imaging is frequently ordered. We assessed the benefits of this additional imaging. Our hypothesis was that additional imaging in lower acuity trauma consults results in the diagnosis of new significant injuries with a change in treatment plan and increased Injury Severity Score (ISS). The registry at our Level I trauma center was queried from November 2015 to November 2016 for trauma consults initially evaluated by ED physicians. Patients with mild to moderate injuries were included. Injury findings before and after additional imaging were determined by chart review and pre- and postimaging ISS were calculated. Blinded trauma surgeons assessed the findings for clinical significance and changes in treatment. Four hundred and twenty-one patients were evaluated, 41 were excluded. One hundred and forty patients (37%) underwent additional CT imaging. Forty-seven patients (34%) had additional injuries found, with 16 (12%) increasing their ISS (mean 0.54, SD 1.66). Ninety-three per cent of cases resulted in at least one physician finding the new injuries clinically significant; however, agreement was low (κ = 0.095). For 70 per cent, at least one physician felt the findings warranted a change in treatment plan (κ = 0.405). Additional imaging in ED trauma consults resulted in the identification of new injuries in 1/3 of our patient sample. This suggests that current efforts to limit the use of CT imaging in trauma patients may result in significant injuries going undiscovered and undertreated. Further research is needed to determine the risk of attempts to limit imaging. |
| Databáze: | OpenAIRE |
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