Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Trauma Acute Care Surg. 2012 May;72(5):1255-62. doi: 10.1097/TA.0b013e3182452b6f.
The repetition of computed tomography (CT) imaging in caring for injured patients transferred between institutions is common, but it is not well studied. Our objective is to quantify and describe the characteristics associated with repeating chest and abdominal CT images for patients transferred to trauma centers and to determine whether repeat imaging leads to delays in definitive care or disparate outcomes.
This is a retrospective review of adult, blunt trauma patients transferred to two Level I trauma centers between January 2004 and May 2008 who underwent CT imaging of the chest, abdomen, or both.
60% of patients had at least one study repeated upon arrival to the trauma center. Variables associated with repeat imaging include Injury Severity Scores between 24 and 33 versus <15 (odds radio [OR], 1.6; 95% confidence interval [CI], 1.05-2.4), transfer to University of North Carolina (OR, 1.5; 95% CI, 1.01-2.2), transport by helicopter (OR, 1.6; 95% CI, 1.2-2.2), transfer in any year before 2008 (OR, 2.4; 95% CI, 1.6-3.6 for 2007; OR, 3.4; 95% CI, 2.2-5.3 for 2006; OR, 3.0; 95% CI, 1.8-5.0 for 2005; OR, 2.8; 95% CI, 1.7-4.7 for 2004), and triage alert level higher than the least severe level III (OR, 1.6; 95% CI, 1.01-2.7 for level II; OR, 2.2; 95% CI, 1.2-4.1 for level I). In adjusted models, there was no evidence that repeat imaging neither shortened the total time to definitive care nor altered patient outcomes.
Injured patients often undergo imaging that gets repeated, adding cost and radiation exposure while not significantly altering outcomes. The current policy push to digitize medical records must include provisions for the interoperability and use of imaging software.
III, therapeutic study.
在机构间转移的受伤患者中，重复进行计算机断层扫描（CT）成像很常见，但尚未对此进行充分研究。我们的目的是量化并描述与将患者转移到创伤中心时重复进行胸部和腹部 CT 成像相关的特征，并确定重复成像是否会导致确定性治疗的延迟或结果的差异。
这是对 2004 年 1 月至 2008 年 5 月期间在两个一级创伤中心接受治疗的成年钝器伤患者进行的回顾性研究，这些患者接受了胸部、腹部或两者的 CT 成像。
60%的患者在到达创伤中心时至少有一项研究被重复进行。与重复成像相关的变量包括损伤严重程度评分在 24 至 33 分与<15 分之间（比值比[OR]，1.6；95%置信区间[CI]，1.05-2.4）、转运至北卡罗来纳大学（OR，1.5；95% CI，1.01-2.2）、直升机转运（OR，1.6；95% CI，1.2-2.2）、在 2008 年之前的任何一年转运（OR，2.4；95% CI，2007 年为 1.6-3.6；OR，3.4；95% CI，2006 年为 2.2-5.3；OR，3.0；95% CI，2005 年为 1.8-5.0；OR，2.8；95% CI，2004 年为 1.7-4.7）和分诊警示级别高于最不严重的 III 级（OR，1.6；95% CI，II 级为 1.01-2.7；OR，2.2；95% CI，I 级为 1.2-4.1）。在调整后的模型中，没有证据表明重复成像既没有缩短确定性治疗的总时间，也没有改变患者的结局。
受伤患者经常接受重复成像，这增加了成本和辐射暴露，而对结局没有明显改变。当前推动将医疗记录数字化的政策必须包括对互操作性和成像软件使用的规定。
III 级，治疗性研究。
