Implementation of Institutional Triaging Algorithms Decreases Head and Neck MDCT Use in Blunt Trauma
| Autor: | Asim Mian, Courtney Takahashi, Tejal S. Brahmbhatt, Edward K. Sung, Anoop Ravilla, Osamu Sakai, Mrugesh Patel, Arthur H. Baghdanian, Chad Farris, Hannah Burley, Daniel Adran, Aayushi Rai, Hyunjoong Kim |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Adolescent Trauma registry Wounds Nonpenetrating 030218 nuclear medicine & medical imaging law.invention Neck Injuries 03 medical and health sciences 0302 clinical medicine Injury Severity Score law Multidetector Computed Tomography Medicine Craniocerebral Trauma Humans Radiology Nuclear Medicine and imaging In patient Head and neck APACHE Aged Retrospective Studies Aged 80 and over business.industry Patient Selection Retrospective cohort study Length of Stay Middle Aged Intensive care unit Health evaluation Blunt trauma 030220 oncology & carcinogenesis Female Triage business Algorithm Algorithms |
| Zdroj: | Radiology. 298(3) |
| ISSN: | 1527-1315 |
| Popis: | Background Multidetector CT (MDCT) enables rapid and accurate diagnosis of head and neck (HN) injuries in patients with blunt trauma (BT). However, MDCT is overused, and appropriate selection of patients for imaging could improve workflow. Purpose To investigate the effect of implementing clinical triaging algorithms on use of MDCT in the HN in patients who have sustained BT. Materials and Methods In this retrospective study, patients aged 15 years or older with BT admitted between October 28, 2007, and December 31, 2013, were included. Patients were divided into pre- and postalgorithm groups. The institutional trauma registry and picture archiving and communication system reports were reviewed to determine which patients underwent MDCT of the head, MDCT of the cervical spine (CS), and MDCT angiography of the HN at admission and whether these examinations yielded positive results. Injury Severity Score, Acute Physiology and Chronic Health Evaluation II score (only those patients in the intensive care unit), length of hospital stay (LOS), length of intensive care unit stay (ICULOS), and mortality were obtained from the trauma registry. Results A total of 8999 patients (mean age, 45 years ± 20 [standard deviation]; age range, 15-101 years; 6027 male) were included in this study. A lower percentage of the postalgorithm group versus the prealgorithm group underwent MDCT of the head (55.8% [2774 of 4969 patients]; 95% CI: 54.4, 57.2 vs 64.2% [2589 of 4030 patients]; 95% CI: 62.8, 65.7; P .99). Pre- versus postalgorithm groups did not differ in LOS (mean, 4.8 days ± 7.1 vs 4.5 days ± 7.1, respectively; P = .42), ICULOS (mean, 4.6 days ± 6.6 vs 4.8 days ± 6.7, respectively; P > .99), or mortality (2.9% [118 of 4030 patients]; 95% CI: 2.5, 3.5; vs 2.8% [141 of 4969 patients]; 95% CI: 2.4, 3.3; respectively; P > .99). Conclusion Implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT of the head and cervical spine in patients who experienced blunt trauma, without increased adverse outcomes. © RSNA, 2021 See also the editorial by Munera and Martin in this issue. |
| Databáze: | OpenAIRE |
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