Wan Yang, Stewart Kenneth E, Lansdale Martin Q
Oklahoma State Department of Health, Emergency Systems, Protective Health Services, 1000 NE 10th Street, Oklahoma City, 73117-1299, USA.
Emerg Radiol. 2018 Aug;25(4):349-356. doi: 10.1007/s10140-018-1581-3. Epub 2018 Feb 8.
Computed tomography (CT) scans play a vital role in the diagnosis and evaluation of trauma patients. Repeat CT scans occurred often among transferred trauma patients. The objective was to describe CT use and identify patient- and hospital-level factors associated with repeat CT scans among inter-facility transferred major trauma patients.
A retrospective cohort study was conducted using data extracted from the Oklahoma State Trauma Registry between 2009 and 2015. Both bivariate and multivariate analyses were employed to assess the factors associated with repeat CT scans.
During the 7-year study period, 8678 major trauma patients were transferred between acute-care hospitals in Oklahoma. Among them, 4311 patients had at least one repeat CT scan. Head CT scans were the most commonly performed as well as repeated. Bivariate analysis showed that differences in repeat CT scans were associated with age, injury type, injury severity score, head injury severity, revised trauma score, payer source, transport mode to referring facilities, and facility levels at the 5% level. Multivariate analysis showed the odds of repeat CT scans were higher for adult and geriatric patients, patients with blunt injuries, severely injured patients, patients with severe head injuries, patients with a good revised trauma score, patients discharged alive, and mode to referring facilities.
Our study demonstrated that inter-facility transfers within an organized rural trauma system often underwent repeat CT scans. The large proportion of patients with multiple and repeated CT scans should underline the importance of trauma systems evaluating the necessity of CT scans, image-sharing capability, and obtaining appropriate scans in order to optimize use. Overall, reducing unnecessary CT scans should be an essential part of trauma care quality improvement efforts.
计算机断层扫描（CT）在创伤患者的诊断和评估中起着至关重要的作用。重复CT扫描在转诊创伤患者中经常出现。目的是描述CT的使用情况，并确定在机构间转诊的严重创伤患者中与重复CT扫描相关的患者和医院层面的因素。
采用回顾性队列研究，使用从俄克拉荷马州创伤登记处提取的2009年至2015年的数据。采用双变量和多变量分析来评估与重复CT扫描相关的因素。
在7年的研究期间，8678名严重创伤患者在俄克拉荷马州的急症医院之间转诊。其中，4311名患者至少进行了一次重复CT扫描。头部CT扫描是最常进行以及重复进行的。双变量分析显示，重复CT扫描的差异在5%的水平上与年龄、损伤类型、损伤严重程度评分、头部损伤严重程度、修订创伤评分、支付方来源、转诊机构的运输方式以及机构级别有关。多变量分析显示，成年和老年患者、钝性损伤患者、重伤患者、重度头部损伤患者、修订创伤评分良好的患者、存活出院的患者以及转诊机构的运输方式进行重复CT扫描的几率更高。
我们的研究表明，在有组织的农村创伤系统内进行机构间转诊的患者经常接受重复CT扫描。大量进行多次和重复CT扫描的患者应突出创伤系统评估CT扫描必要性、图像共享能力以及进行适当扫描以便优化使用的重要性。总体而言，减少不必要的CT扫描应是创伤护理质量改进工作的重要组成部分。
