Declining trend in the use of repeat computed tomography for trauma patients admitted to a level I trauma center for traffic-related injuries

https://doi.org/10.1016/j.ejrad.2012.12.007Get rights and content

Abstract

Objective

To evaluate the trend in utilization of repeat (i.e. ≥2) computed tomography (CT) and to compare utilization patterns across body regions for trauma patients admitted to a level I trauma center for traffic-related injuries (TRI).

Materials and Methods

We linked the Harborview Medical Center trauma registry (1996–2010) to the billing department data. We extracted the following variables: type and frequency of CTs performed, age, gender, race/ethnicity, insurance status, injury mechanism and severity, length of hospitalization, intensive care unit (ICU) admission and final disposition. TRIs were defined as motor vehicle collisions, motorcycle, bicycle and pedestrian-related injuries. Logistic regression was used to evaluate the association between utilization of different body region repeat (i.e. ≥2) CTs and year of admission, adjusting for patient and injury-related characteristics that could influence utilization patterns.

Results

A total of 28,431 patients were admitted for TRIs over the study period and 9499 (33%) received repeat CTs. From 1996 to 2010, the proportion of patients receiving repeat CTs decreased by 33%. Relative to 2000 and adjusting for other covariates, patients with TRIs admitted in 2010 had significantly lower odds of undergoing repeat head (OR = 0.61; 95% CI: 0.49–0.76), pelvis (OR = 0.37; 95% CI: 0.27–0.52), cervical spine (OR = 0.23; 95% CI: 0.12–0.43), and maxillofacial CTs (OR = 0.24; 95% CI: 0.10–0.57). However, they had higher odds of receiving repeat thoracic CTs (OR = 1.86; 95% CI: 1.02–3.38).

Conclusion

A significant decrease in the utilization of repeat CTs was observed in trauma patients presenting with traffic-related injuries over a 15-year period.

Introduction

Traffic-related injuries (TRI) are the leading cause of morbidity and mortality in children and young adults in the United States [1]. Even among older individuals, TRIs are among the top 10 leading causes of death. The total direct and indirect burden of these injuries in the United States has been estimated to exceed $230.6 billion in 2000 [2].

Computed tomography (CT) is the imaging modality of choice for the management of trauma in emergency departments and during hospitalization [3]. Since its introduction in 1970, CT has revolutionized diagnostic radiology by providing precise images that could not be obtained through other non-invasive modalities [4], [5], [6], [7]. Studies have demonstrated substantial increases in CT utilization, particularly among patients treated in emergency departments [6], [8], [9], [10], [11]. Multiple factors have been suggested to be involved in the escalating trend in utilization, including availability and affordability of this modality [12], patient demands [13], defensive medicine [14], financial incentives [15] and aging of the population.

The increase in the utilization rate of CT raises two major concerns. First, CT emits ionizing radiation that has potential carcinogenic effects for individuals exposed to repeat scans [7], [16], [17]. This issue is particularly important when considering CT utilization in the pediatric population [18]. Second, advanced imaging technologies have contributed to increasing the cost of care because of the high cost per study as well as the high frequency of use [7].

This study evaluated the trend in utilization of repeat (i.e. ≥2) CT for trauma patients admitted to a level I trauma center for TRIs after adjustment for potential confounding variables.

Section snippets

Materials and methods

We linked the trauma registry and billing department data from Harborview Medical Center (HMC), the only level I trauma utilization in the Northwest United States covering Washington, Idaho, Montana and Alaska. From the linked databases, we extracted the following variables: age, gender, race/ethnicity, insurance status, mechanism of injury, injury severity score (ISS), length of hospitalization, intensive care unit (ICU) admission, final disposition (dead vs. alive), year of admission and type

Results

A total of 28,431 trauma patients were admitted to HMC for TRIs from 1996 to 2010 (average of 1895 patients per year) and 20,748 (73%) of these patients received at least one CT during hospitalization, while 9207 (32%) received at least one repeat CT. The majority of TRIs involved motor vehicle injuries (63%), followed by motorcycle (15%), pedestrian (13%), and bicycle-related injuries (8%). The distributions of age, gender, race/ethnicity, insurance status, ISS, length of hospitalization, ICU

Discussion

In this study, we described long-term utilization trends (1996–2010) in the use of repeat CTs for trauma patients admitted to a single level I trauma utilization for TRIs. We observed significant decreases in utilization of repeat head, pelvis, abdomen, and cervical spine CTs and increased use of repeat thorax CTs in this patient population.

Utilization of advanced imaging technologies, including CT, is of a special concern at level I trauma utilizations for a number of reasons. First, these

Conclusion

In conclusion, in spite of most other studies that have demonstrated an increasing trend in CT use, we observed a declining trend in the use of repeat CTs. Our future studies will focus on identifying factors that have contributed to this utilization pattern.

Role of funding source

This research was partially supported by NIH grant #RO1-AA017497.

Conflict of interest

No conflicts of interest exist for any of the authors.

References (25)

  • F.K. Korley et al.

    Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007

    Journal of the American Medical Association

    (2010)
  • M. Bhargavan

    Trends in the utilization of medical procedures that use ionizing radiation

    Health Physics

    (2008)
  • Cited by (0)

    1

    Tel.: +1 206 744 9437.

    2

    Tel.: +1 206 744 9861.

    3

    Tel.: +1 206 744 9430.

    4

    Tel.: +1 206 744 3561.

    View full text