Highlights from AAST - reducing CT scanning

The group from San Diego shows that is IS possible to treat blunt trauma patients without pan-scanning.

BACK TO THE FUTURE: REDUCING RELIANCE ON TORSO CT IN THE INITIAL EVALUATION OF BLUNT TRAUMA Michael J. Sise*, M.D., Jessica Kahl, B.A., Richard Y. Calvo, M.P.H., C. Beth Sise, J.D., R.N., Jessica Morgan, M.D., Meghan C. Shackford, Jesse Bandle, M.D., Seth Krosner, M.D. , Kimberly Peck, M.D.*, Steven R. Shackford*, M.D., Jack Yang, M.D., Scripps Mercy Hospital Trauma Service Invited Discussant: William Bromberg Introduction: Current reliance on chest-abdomen-pelvis (CAP) computed tomography in the initial evaluation of blunt trauma is a major source of patient radiation exposure. Our Level I trauma center surgeon practice group (SPG) modified its guideline in 2011 to limit the use of CAP. We evaluated the effect of this practice change on CAP use and diagnostic accuracy. Methods: We compared data on blunt injury trauma activations evaluated by the 5-member SPG for two 6-month intervals, before (T1) and after (T2) instituting the practice change. Patient demographic and injury data, complications, torso imaging and radiation dosage in millisieverts per patient (msv/pt) were collected. Following analysis of T1, the surgeon with the lowest CAP use was identified and found to have no errors or delays in diagnosis. The SPG agreed to adopt this surgeon's focus on findings of the physical exam and FAST to reduce CAP use in the initial evaluation. T2 was analyzed to assess the effect of implementation of this guideline. T1 T2 p-value Results: There were 897 patients in T1 and 897 948 948 in T2 (Table). Patients did not differ by Patients Age, mean 46.5 46.4 p=NS age, gender, mortality, or probability of Female, % 68.5 67.4 p=NS survival (Ps). Rate of CAP use decreased by Mortality, % 2.9 2 p=NS 38.5% with a significant drop in mean Ps, mean 96.1 96.6 p=NS radiation exposure (p<0.01). There were no CAP, % 67.1 41.3 p<0.01 missed injuries or delays in diagnosis in msv/pt, mean 14.04 8.58 p<0.01 either interval. Conclusion: The use of CAP and its associated radiation burden in the initial evaluation of blunt trauma can be reduced without diagnostic errors by comparing utilization and identifying best practice. This process has implications for trauma resource utilization, patient safety, and quality of care.