Pan-Computed Tomography for Blunt Trauma Patients May Be Overused

Sakorafas, Lois; Rogers, Frederick B.

doi:10.1097/ta.0b013e3181d9d7d1

Cited by 2 publications

(3 citation statements)

References 3 publications

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“…Studies in several other countries have identified adverse events, including death, that occur in trauma centers because of their failure to adopt best practices [ 9 - 13 ]. Aside from underusing proven therapies, there is also evidence of overuse of diagnostic procedures with known side effects, such as full-body computerized tomography (CT) scanning that exposes patients to unnecessary ionizing radiation that may increase the risk of cancer [ 14 , 15 ]. An estimated one million children every year in the US are unnecessarily imaged with CT [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

Archambault

Turgeon²,

Witteman³

et al. 2015

JMIR Res Protoc

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BackgroundTrauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting.ObjectiveOur main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec.MethodsFirst, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected—one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry.ResultsThis project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months.ConclusionsWe expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions.

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Section: Introductionmentioning

confidence: 99%

Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

Archambault

Turgeon²,

Witteman³

et al. 2015

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

“…Exposure to greater than 20 mSv carries a cancer risk of more than one in 1000 based on theoretical population‐weighted estimates . Other potential harms of liberal whole‐body CT scanning include cost, delays to other scans, underestimation of injury extent (due to poor initial demarcation), false reassurance in eliminating hollow viscus and other occult injuries, and incidental non‐traumatic findings …”

Section: Introductionmentioning

confidence: 99%

“…21 Other potential harms of liberal whole-body CT scanning include cost, delays to other scans, underestimation of injury extent (due to poor initial demarcation), false reassurance in eliminating hollow viscus and other occult injuries, and incidental non-traumatic findings. 7,12,13,[22][23][24] Given the current controversy, there is a need to develop better prediction criteria to select for trauma patients who are most likely to benefit from wholebody CT, thereby reducing the rate of unnecessary scans. 1,5,10,15,16,22 Although some studies have used Injury Severity Scores (ISS) as the outcome to justify wholebody CT scans, the authors of the present study postulate that the presence of significant injuries in two or more body regions would be a more valid clinical justification.…”

Section: Introductionmentioning

confidence: 99%