Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences?
| Autor: | Michael P. Francois, Geoffrey K. Doughlin, Melissa K. James, Shi-Wen Lee, Sebastian D. Schubl |
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| Rok vydání: | 2017 |
| Předmět: |
Protocol (science)
medicine.medical_specialty business.industry Incidence (epidemiology) Trauma center 030208 emergency & critical care medicine General Medicine Emergency department Confidence interval 030218 nuclear medicine & medical imaging Surgery 03 medical and health sciences symbols.namesake 0302 clinical medicine Blunt trauma Anesthesia Emergency Medicine medicine symbols Prospective cohort study business Fisher's exact test |
| Zdroj: | The American Journal of Emergency Medicine. 35:13-19 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2016.09.027 |
| Popis: | Study Objective The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost. Methods A 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test. Results There were a total of 220 patients in the pre–pan-scan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the emergency department by 68.2 minutes (95% confidence interval [CI], −134.4 to −2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI, −2519 to −411). In contrast, fixed computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, −271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period. Conclusion Although there are advantages to whole-body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol. |
| Databáze: | OpenAIRE |
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