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Use of computed tomography in the setting of a tiered trauma team activation system in Australia

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Abstract

This study aims to describe the patterns in the use of computed tomography (CT) imaging in the setting of a two-tiered trauma team activation system without a mandatory whole-body (“panscan”) trauma CT protocol. A prospective study was conducted at a single inner city major trauma centre in Sydney, Australia. Adult patients presenting to the emergency department requiring a trauma team activation were studied over 1 year. Patients in the trauma consult group met predetermined criteria for mechanism of injury without vital sign abnormalities or clinical evidence of major injury. Full trauma team response patients were those who had abnormal predetermined vital signs or evidence of major injury on initial assessment. The outcomes measured were severe injury, multiregion injury and positive CT scans. Of the patients, 1,058 were studied of whom 63 % had at least one CT scan performed. The most common CT studies were CT brain in combination with cervical spines (23 %) and isolated abdominal CT scans (17 %). The full trauma response group was associated with significantly higher rates of severe injury (34 versus 8 %, p < 0.001), multiregion injury (13 versus 3 %, p < 0.001), need for operative intervention (37 versus 15 %, p < 0.001) and in-hospital mortality (4 versus 0.7 %, p < 0.001). This group was also associated with significantly higher odds of whole-body CT use [odds ratio (OR) 5.6, 95 % confidence interval (CI) 3.6–8.8, p < 0.001] and higher odds of positive CT brain studies compared to the trauma consult group (OR 2.6, 95 % CI 1.7–4.1, p < 0.001). A tiered trauma team activation criteria in combination with trauma team assessment may be used to triage patients requiring CT without the need for mandatory CT protocols based on mechanism alone.

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References

  1. Kane G, Engelhardt R, Celentano J, Koenig W, Yamanaka J, McKinney P et al (1985) Empirical development and evaluation of prehospital trauma triage instruments. J Trauma 25(6):482–489

    Article  PubMed  CAS  Google Scholar 

  2. Gormican SP (1982) CRAMS scale: field triage of trauma victims. Ann Emerg Med 11(3):132–135

    Article  PubMed  CAS  Google Scholar 

  3. Mackersie RC (2006) History of trauma field triage development and the American college of surgeons criteria. Prehosp Emerg Care 10(3):287–294

    Article  PubMed  Google Scholar 

  4. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL et al (2006) A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354(4):366–378

    Article  PubMed  CAS  Google Scholar 

  5. Phillips S, Rond PC 3rd, Kelly SM, Swartz PD (1996) The failure of triage criteria to identify geriatric patients with trauma: results from the Florida trauma triage study. J Trauma 40(2):278–283

    Article  PubMed  CAS  Google Scholar 

  6. Chang DC, Bass RR, Cornwell EE, Mackenzie EJ (2008) Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg 143(8):776–781, discussion 782

    Article  PubMed  Google Scholar 

  7. Mohan D, Rosengart MR, Farris C, Cohen E, Angus DC, Barnato AE (2011) Assessing the feasibility of the American college of surgeons' benchmarks for the triage of trauma patients. Arch Surg 146(7):786–792

    Article  PubMed  Google Scholar 

  8. Ciesla DJ, Sava JA, Street JH 3rd, Jordan MH (2008) Secondary overtriage: a consequence of an immature trauma system. J Am Coll Surg 206(1):131–137

    Article  PubMed  Google Scholar 

  9. Claridge JA, Golob JF, Leukhart WH, Kan JA, Como JJ, Malangoni MA, Yowler CJ (2010) Trauma team activation can be tailored to prehospital criteria. Am Surg 76(12):1401–1407

    PubMed  Google Scholar 

  10. Kouzminova N, Shatney C, Palm E, McCullough M, Sherk J (2009) The efficacy of a two tiered trauma activation system at a level one trauma centre. J Trauma 67:829–833

    Article  PubMed  Google Scholar 

  11. Rehn M, Lossius HM, Tjosevik KE, Vetrhus M, Ostebo O, Eken T (2012) Efficacy of a two tiered trauma activation protocol in a Norwegian Trauma Centre. British J Surg 99:199–208

    Article  CAS  Google Scholar 

  12. Smith DC, Chapital A, Burgess Uperesa BM, Smith ER, Ho C, Ahana A (2011) Trauma activations and their effect on non trauma patients. J Emerg Med 41(1):90–94

    Article  PubMed  Google Scholar 

  13. Smith CM, Woolrich-Burt L, Wellings R, Costa ML (2011) Major trauma CT scanning: the experience of a regional trauma centre in the UK. Emerg Med J 28:378–382

    Article  PubMed  Google Scholar 

  14. Aucar JA, Fernandez L, Wagner-Mann C (2007) If a picture is worth a thousand words, what is a trauma computerized tomography panel worth? Am J Surg 194:734–740

    Article  PubMed  Google Scholar 

  15. Tillou A, Gupta M, Baraff LJ (2009) Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma-Inj Infect Crit Care 67:779–787

    Article  Google Scholar 

  16. Sun Z, Ng KH, Vijayananthan A (2010) Is utilisation of computed tomography justified in clinical practice? Part I: application in the emergency department. Singapore Med J 51:200–206

    PubMed  CAS  Google Scholar 

  17. Blackmore CC (2005) Clinical prediction rules in trauma imaging. Who how and why? Radiology 235:371–374

    Article  PubMed  Google Scholar 

  18. Hadley JL, Agola J, Wong P (2006) Potential impact of the American College of Radiology appropriateness criteria on CT for trauma. AJR 186:937–942

    Article  PubMed  Google Scholar 

  19. Baker SP, O'Neill B, Haddon W (1974) The Injury Severity Score. A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–193

    Article  PubMed  CAS  Google Scholar 

  20. Davis T, Dinh M, Roncal S, Byrne C, Petchell J, Leonard E et al (2010) Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital. Injury 41(5):470–474

    Article  PubMed  Google Scholar 

  21. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, Eisenhauer MA, McKnight RD, Bandiera G, Holroyd B et al (2005) Comparison of the Canadian head CT rule and New Orleans criteria in patients with minor head injury. JAMA 294(12):1511–1518

    Article  PubMed  CAS  Google Scholar 

  22. Stiell IG, Clement CM, McKnight D, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhaur MA et al (2003) The Canadian C spine rule versus the NEXUS low risk criteria in patients with trauma. N Eng J Med 349:2510–2518

    Article  CAS  Google Scholar 

  23. Hutter M, Woltmann A, Hierholzer C, Gartner C, Buhren V, Stengel D (2011) Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 19:73–81

    Article  PubMed  Google Scholar 

  24. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D (2006) Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 141:468–475

    Article  PubMed  Google Scholar 

  25. Deunk J, Brink M, Dekker HM, Kool DR, Kuijk CV, Blickman JG, Vugt AB, Edwards MJ (2009) Routine versus selective computed tomography of the abdomen pelvis and lumbar spine in blunt trauma: a prospective evaluation. J Trauma 66:1108–1117

    Article  PubMed  Google Scholar 

  26. Snyder GE (2008) Whole-body imaging in blunt multisystem trauma patients who were never examined. Ann Emerg Med 52:101–103

    Article  PubMed  Google Scholar 

  27. Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) (2005) Code of practice for the exposure of humans to ionizing radiation for research purposes. ARPANSA, Yallambie

    Google Scholar 

  28. Asha S, Curtis KA, Grant N et al (2012) Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol. Emerg Med Australas 24:43–51

    Article  PubMed  Google Scholar 

  29. Brenner DJ, Elliston CD (2004) Estimated radiation risks potentially associated with full body CT screening. Radiology 232:735–738

    Article  PubMed  Google Scholar 

  30. Rehani MM, Berry M (2004) Radiation doses in computed tomography: the increasing doses of radiation need to be controlled. BMJ 320:593–594

    Article  Google Scholar 

  31. Diercks DB, Mehrotra A, Nazarian DJ, Promes SB, Decker WW, Fesmire FM (2011) Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Ann Emerg Med 57:387–404

    Article  PubMed  Google Scholar 

  32. Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, van Vugt AB, Edwards MJ (2010) Predictors for the selection of patients for abdominal CT after blunt trauma. Ann Surg 251:512–520

    Article  PubMed  Google Scholar 

  33. Kaiser ML, Whealon MD, Barrios C, Dobson SC, Malinoski DJ, Dolich MO, Lekawa ME et al (2011) Risk factors for traumatic injury findings on thoracic computed tomography in patients with blunt trauma having a normal chest radiograph. Arch Surg 146(4):495–463

    Article  Google Scholar 

  34. Bailitz J, Starr F, Beecroft M, Bankoff J, Roberts R, Bokhari F, Joseph K, Wiley D et al (2009) CT should replace three view radiographs as the initial screening test in patients at high moderate and low risk for blunt cervical spine injury: a prospective comparison. J Trauma 66:1605–1609

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia

    Michael M. Dinh, Kai H. Hsiao & Kendall J. Bein

  2. Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia

    Michael M. Dinh & Susan Roncal

  3. Department of Radiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia

    Charbel Saade, Kee Fung Chi & Richard Waugh

Authors
  1. Michael M. Dinh
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  2. Kai H. Hsiao
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  3. Kendall J. Bein
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  4. Susan Roncal
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  5. Charbel Saade
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  6. Kee Fung Chi
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  7. Richard Waugh
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Correspondence to Michael M. Dinh.

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All authors listed above have made substantial contribution to the study design, data acquisition, manuscript review and approval for submission.

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Dinh, M.M., Hsiao, K.H., Bein, K.J. et al. Use of computed tomography in the setting of a tiered trauma team activation system in Australia. Emerg Radiol 20, 393–400 (2013). https://doi.org/10.1007/s10140-013-1124-x

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  • DOI: https://doi.org/10.1007/s10140-013-1124-x

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