Sat., 10/16/10 Polytrauma & Femur, Paper #76, 11:32 am OTA-2010
Radiation Exposure Has Increased in Trauma Patients over Time
Kasra Ahmadinia, MD; Ben Smucker, MD; Clyde L. Nash, MD; Heather A. Vallier, MD;
MetroHealth Medical Center, Cleveland, Ohio, USA
Purpose: Diagnostic imaging is a burgeoning industry. One of the settings in which CT scans are utilized the most often is acute trauma. Emergent CT scans of the head, spine, chest, abdomen, and pelvis have become imaging modalities of choice in trauma centers around the country. The purpose of this study was to evaluate the trend of radiation exposure in acute trauma patients in a busy Level 1 trauma center and determine if there were associations with injury severity and acute survival of the patient. Our hypothesis was that the number of radiological tests, amount of radiation within 24 hours of injury, and cost would increase over time without change in patient acuity or outcome.
Methods: 100 consecutive trauma patients at an urban Level 1 trauma center were retrospectively reviewed each year for the years 2002, 2005, and 2008. Trauma patients are categorized based on severity of initial injury as category 1 or category 2 (less injury). The total number of CT scans and total dosage of radiation (mSV) were determined. Total charges were also calculated based on the 2008 technical and professional charges for each diagnostic study. Injury types and injury severity scores (ISS) were characterized for each patient and controlled for during our analysis. Mortality rate was calculated for each year for the entire trauma population.
Results: Mean ISS scores for category 1 patients in 2002, 2005, and 2008 were 15, 13.2, and 16.7, respectively (P = 0.43). Mean ISS scores for category 2 patients in 2002, 2005, and 2008 were 9.4, 9.4, and 8.6, respectively (P = 0.60). The mean number of CT scans for category 1 patients in 2002, 2005, and 2008 was 1.5, 3.5, and 4.2, respectively (P = 0.01). This trend was similar in category 2 patients: 2.0, 3.8, 4.6, respectively (P < 0.01). This contributed to increased total radiation exposure to category 1 and category 2 patients over 2002, 2005, and 2008: 12.4 mSV, 28.0 mSV, 28.5 mSV (P = 0.02); and 17.8 mSV, 26.3 mSV, 33.6 mSV (P < 0.001), respectively. The charges (based on 2008 charges) for diagnostic imaging per patient also increased for category 1 and category 2 patients over 2002, 2005, and 2008: $2933, $5442, $5608; and $4104, $5912, $6750, respectively (all P < 0.01). Over the course of a year for 4800 trauma patients treated at our hospital, this is expected to accrue additional charges of $12.8 million. Mortality of all trauma patients during 2002, 2005, and 2008 was 4.0%, 3.0%, and 4.0%, respectively.
Conclusion: The number of CT scans in our trauma patients has more than doubled over 6 years, generating more radiation exposure and charges per patient. While scans are intended to diagnose and characterize known or occult injuries, the mortality rate in our study was similar between the three study periods despite more CT scans and no change in injury severity. Given that previous studies have demonstrated that increased radiation is a risk factor for developing cancer, the clinician is responsible for balancing the risks of missing an acute injury versus potentially contributing to a long-term one. Furthermore, judicious utilization of advanced imaging technologies may help to contain costs without compromising the level of care.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.