Liepert Amy E, Bledsoe Joseph, Stevens Mark H, Cochran Amalia
Department of Surgery, University of Wisconsin, Madison, WI, USA.
Department of Emergency Medicine, Murray, UT, USA.
Am J Surg. 2014 Oct;208(4):511-6. doi: 10.1016/j.amjsurg.2014.05.014. Epub 2014 Jul 23.
Duplicated computed tomography (CT) scans in transferred trauma patients have been described in university-based trauma systems. This study compares CT utilization between a university-based nonintegrated system (NIS) and a vertically integrated regional healthcare system (IS).
Trauma patients transferred to 2 Level I trauma centers were prospectively identified at the time of transfer. Imaging obtained before and subsequent to transfer and the reason for CT imaging at the Level I center were captured by real-time reporting.
Four hundred eighty-one patients were reviewed (207 at NIS and 274 at IS). Ninety-nine patients (48%) at NIS and 45 (16%) at IS underwent duplicate scanning of at least one body region. Inadequate scan quality and incomplete imaging were the most common reason category reported at NIS (54%) and IS (78%).
Fewer patients received duplicated scans within the vertically IS as compared with a traditional university-based referral system. Our findings suggest that the adoption of features of a vertically IS, particularly improved transferability of radiographic studies, may improve patient care in other system types.
在以大学为基础的创伤系统中，已报道过转院创伤患者重复进行计算机断层扫描（CT）的情况。本研究比较了以大学为基础的非整合系统（NIS）和垂直整合的区域医疗系统（IS）之间的CT使用情况。
前瞻性地确定转至2个一级创伤中心的创伤患者。通过实时报告获取转院前和转院后获得的影像以及在一级中心进行CT成像的原因。
共审查了481例患者（NIS为207例，IS为274例）。NIS有99例患者（48%），IS有45例患者（16%）至少对一个身体区域进行了重复扫描。扫描质量不足和成像不完整是NIS（54%）和IS（78%）报告的最常见原因类别。
与传统的以大学为基础的转诊系统相比，垂直整合的IS内接受重复扫描的患者较少。我们的研究结果表明，采用垂直整合系统的特点，特别是提高影像学研究的可转移性，可能会改善其他系统类型中的患者护理。
