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