Impact on trauma patient management of installing a computed tomography scanner in the emergency department

Lee, K.L.; Graham, Colin A.; Lam, Jenny M.Y.; Yeung, John H.K.; Ahuja, Anil T.; Rainer, Timothy Hudson

doi:10.1016/j.injury.2008.12.001

Cited by 29 publications

(28 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…have all shown similar results with faster times to CT leading to a decrease in mortality in the same patient population (severely injured) . Another study by Lee et al ., however, found no improvement in HLOS or mortality with faster times to CT following installation of an ED scanner …”

Section: Discussionmentioning

confidence: 99%

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre

Kim

Dobson

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background Computed tomography (CT) is an essential diagnostic tool for severe multi‐trauma patients. International guidelines recommend an optimal time of 1 h from arrival. The aim of this study was to determine the time interval from arrival at the emergency department to CT for all trauma patients and the effects on in‐hospital mortality and hospital length of stay. Methods Retrospective study of all patients who triggered a trauma call and underwent CT scanning at the Gold Coast University Hospital from January 2016 to December 2017. Exclusion criteria were scans performed at peripheral hospitals or performed more than 5 h after arrival to emergency department. Results One thousand six hundred and nineteen eligible trauma patients were admitted over the study period and underwent CT scanning. Median time to CT was found to be 43 min. CTs done within 1 h compared to those done after 1 h from emergency department arrival were found to have a higher mean injury severity score (11 ± 10 versus 9 ± 9, P = 0.003), a longer mean hospital length of stay (9 ± 21 versus 7 ± 13 days, P = 0.012) and no difference in mortality rates (2.2% versus 2.1%, P = 1.000). Age, injury severity score and intubation status were identified as independent predictors for longer hospital length of stay and higher mortality while time to CT did not. Injury severity score was shown to be an independent predictor of time to CT. Conclusion Our time to CT scanning is well within the timeframe recommended by international guidelines. Early CT scanning may also improve outcomes in severely injured trauma patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre

Kim

Dobson

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…However, of those studies only Saltzherr et al and Lee et al focussed on clinical outcomes, both showing no significant differences in 30-day and 1-year mortality, H-LOS, and ICU-LOS. They concluded that implementing a CT scanner in the ED showed a faster availability of first CT [11, 26]. However, the power of the study of Saltzherr et al, using prespecified groups (multiple trauma patients and severe trauma brain injury patients), was low [11].…”

Section: Discussionmentioning

confidence: 99%

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

Hout

Wilden

Boot

et al. 2017

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

BackgroundTo 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.MethodsIn 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.Results405 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.ConclusionPatients 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.

show abstract

“…9 Second, CT may facilitate more rapid assessment and, when needed, intervention, leading to more expeditious patient disposition from the ED. 10,11 Finally, the increased use of advanced imaging techniques, including CT, is increasingly viewed to be the standard of care for many situations, from both physician and patient perspectives. 10 Given these factors, we posited that the implementation of a preauthorization neuroradiology CT policy would lead to a proliferation of ED CT utilization; however, our results indicate that this was not the case.…”

Section: Discussionmentioning

confidence: 99%

“…One group found that installation of a dedicated ED CT resulted in no significant increase in the number CT scans deemed to be unecessary. 11 Another group found that the utilization of CT studies of the head increased over time within a community hospital setting but not within a tertiary hospital setting, possibly owing to differing levels of expertise and reliance on advanced imaging to facilitate patient management in different hospitals. 9 Our results suggest that the implementation of a preauthorization policy for neuroradiology CT scans is not the source of an increase in after-hours CT use at a tertiary ED and, in contrast and by extension, may be an effective tool to increase ED efficiency while maintaining appropriate CT utilization.…”

Section: Discussionmentioning

confidence: 99%

Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

Dhanoa

Burton

Tilly

et al. 2013

CJEM

View full text Add to dashboard Cite

Objective: To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT). Methods: All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre-and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies. Results: During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre-and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre-and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre-and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (p value 5 0.061 for a difference between groups). Conclusion: Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policies may be unfounded, and further research in this area is warranted. RÉ SUMÉObjectif: L'é tude visait à é valuer l'incidence d'une rè gle d'autorisation pré alable automatique au service des urgences (SU) sur le taux de recours à la tomodensitomé trie (TDM), en neuroradiologie, aprè s les heures normales de travail. Mé thode: Tous les examens de la tê te faits par TDM avec contraste des os de la face, des orbites, de la colonne verté brale, et du cou, demandé s par le SU et effectué s du 1er janvier 2004 au 31 dé cembre 2010 ont é té revus. La rè gle d'autorisation pré alable est entré e en vigueur le 25 fé vrier 2008. Un groupe té moin d'imagerie de la tê te par TDM sans contraste a servi d'ensemble de ré férence. Il y a eu comparaison des taux de recours à la TDM, avant et aprè s l'entré e en vigueur de la rè gle, entre le groupe té moin d'imagerie de la tê te par TDM sans contraste et le groupe à l'é tude d'imagerie par TDM, en neuroradiologie. Ré sultats: Au cours de la pé riode à l'é tude, il y a eu 408,501 consultations au SU, et 20,703 examens ont é té effectué s par TDM, en neuroradiologie. Le nombre total d'examens de la tê te par TDM sans contraste, effectué s dans les groupes avant et aprè s l'entré e en vigueur de la rè gle s'é levait à 7,474 et à 6,094, respectivement, tandis que le nombre total de tous les autres examens faits par TDM, en neuroradiologie, dans les groupes avant et aprè s l'entré e en vigueur de la rè gle s'é levait à 3,833...

show abstract

Impact on trauma patient management of installing a computed tomography scanner in the emergency department

Cited by 29 publications

References 9 publications

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre

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

Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

Contact Info

Product

Resources

About