Airway, breathing, computed tomographic scanning: duplicate computed tomographic imaging after transfer to trauma center.
Airway, breathing, computed tomographic scanning: duplicate computed tomographic imaging after transfer to trauma center.
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DOI：
10.1097/ta.0b013e3182789399
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发表时间：
2013-03
期刊：
影响因子：
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通讯作者：
Freeman K
中科院分区：
文献类型：
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作者：
Moore HB;Loomis SB;Destigter KK;Mann-Gow T;Dorf L;Streeter MH;Ebert GM;Crookes BA;Leffler SM;O'Keefe MF;Freeman K
背景在社区医院进行成像的创伤患者在转移到区域创伤中心（RTC）后通常会接受重复的计算机断层扫描（CT）成像。 CT 扫描费用昂贵、资源密集，并且已知对患者存在辐射风险。本研究的目的是回顾和评估从外部医院 (OSH) 转入我们 RTC 的创伤患者的频率、适应症、对患者管理的影响，以及相关的辐射和重复 CT 成像费用。 方法 对 2009 年 9 月至 2010 年 8 月期间转入我们 RTC 的患者进行前瞻性评估。职业安全与卫生患者的图表和提供者访谈被用来确定重复扫描的原因。主要结果是重复 CT 扫描的频率，定义为 24 小时内同一身体部位的重复 CT 图像。对重复成像的原因以及对患者管理的影响进行了分类。还确定了辐射暴露和重复扫描的费用。 结果 在转移到我们机构的 185 名患者中，有 177 名符合资格。 OSH 对 137 名患者（77%）进行了 CT 检查。 38 名患者（28%）进行了重复 CT 检查。重复 CT 扫描的最常见原因是通过 CD-ROM 发送的图像缺乏薄切片多平面数据 (37%)。 16 名患者 (42%) 的治疗发生了变化。进行重复扫描的患者接受中位数为 10.2 mSv（四分位数范围，6.6-15.7 mSv）的额外辐射，中位费用为 409 美元（四分位数范围，307-734 美元）。 结论 对转移的创伤患者进行的重复扫描中，有三分之一以上是可以避免的，这主要是由于 OSH CT 扫描数据传输不足。单个 CD-ROM 的容量不足以包含创伤扫描的完整成像数据，建立与 OSH 成像数据的直接链接将减少对转移的创伤患者进行重复 CT 扫描的次数。
BACKGROUNDTrauma patients imaged at community hospitals often receive duplicate computed tomographic (CT) imaging after transfer to regional trauma centers (RTCs). CT scanning is expensive, is resource intensive, and has acknowledged radiation risk to the patient. The objective of this study was to review and evaluate the frequency, indications, impact on patient management, as well as associated radiation and charges for duplicate CT imaging of trauma patients transferred to our RTC from outside hospitals (OSH).METHODSPatients transferred to our RTC between September 2009 and August 2010 were evaluated prospectively. The OSH patients’ charts and provider interviews were used to determine the reasons for repeated scans. The primary outcome was frequency of duplicate CT scan, defined as a repeated CT image of the same body part within 24 hours. The reason for duplicate imaging and impact on patient management was categorized. Radiation exposure and charges for duplicate scans were also determined.RESULTSOf the 185 patients transferred to our facility, 177 were eligible. CT examinations at the OSH were performed on 137 patients (77%). A duplicate CT examination occurred in 38 patients (28%). The most common reason for duplicate CT scanning was lack of thin-section multiplanar data, on images sent via CD-ROM (37%). There was a change in management in 16 patients (42%). The patients with duplicate scanning received a median of 10.2 mSv (interquartile range, 6.6–15.7 mSv) of additional radiation, with a median charge of $409 (interquartile range, $307–$734).CONCLUSIONMore than one third of duplicated scans performed on transferred trauma patients were potentially avoidable, primary owing to inadequate transfer of data from the OSH CT scan. The capacity of a single CD-ROM is insufficient to contain full imaging data from a trauma scan, and establishing direct links to imaging data from OSHs would decrease the number of repeated CT scans performed on transferred trauma patients.