Elsevier

Injury

Volume 40, Issue 8, August 2009, Pages 873-875
Injury

Impact on trauma patient management of installing a computed tomography scanner in the emergency department

https://doi.org/10.1016/j.injury.2008.12.001Get rights and content

Abstract

Background

Computed tomography (CT) plays a central diagnostic role for trauma patients. A 16-slice multi-detector CT scanner was installed in the emergency department (ED) of Prince of Wales Hospital in December 2004. The aims of this study were to evaluate the impact of the CT scanner within the ED on trauma management and to compare the utilisation patterns of trauma CT before and after the introduction of EDCT.

Methods

Analysis of prospectively collected trauma registry data. All consecutive trauma cases admitted through the ED that underwent CT between June 2004 and June 2005 (6 months before and after EDCT installation) were included. A positive CT was defined as the identification (by a specialist radiologist) of a significant finding which was consistent with injury.

Results

There were 226 and 202 trauma patients in the 6 months before and after EDCT installation, respectively. 111 (49.1%) patients underwent CT scanning before EDCT compared with 110 (54.5%) afterwards. 72 (65%) patients had CT scans performed before admission to definitive care compared with 99 (90%) after EDCT installed (p < 0.0001, χ2 test). Mean time from arrival to first CT was shorter after EDCT (102 min vs. 197 min, p = 0.011). Mean trauma room length of stay increased after EDCT was implemented (106 min vs. 80 min; p < 0.001). Median time to urgent operation (<6 h) was less with EDCT (134 min before vs. 112 min after). No changes in median time to neurosurgical operation (138 min before vs. 148 min after); mean length of stay (12.8 days before vs. 12.5 days after); or mortality (8 patients before vs. 7 patients after). There were 203 scans (1.8/patient) done before EDCT compared with 226 scans (2.5/patient) after. There was no difference in the number of scans done by body region or the proportion of positive scans (32% before vs. 30% after). Logistic regression confirmed that after adjusting for injury severity and admission physiology, time to first CT was shorter (p = 0.0307) but ED length of stay was increased (p < 0.0001).

Conclusion

After the installation of EDCT, more trauma patients had CT scanning before definitive care, and scans were done sooner, with no significant increase in the number of unnecessary scans.

Introduction

Trauma remains a leading cause of morbidity and is the sixth leading cause of death in Hong Kong.7 Management of the trauma patient is multifactorial,2 but the concept of rapid accurate diagnosis and timely appropriate treatment are central to quality trauma care.3, 5

Advances in imaging have led to computed tomography (CT) scanning playing a central diagnostic role for trauma patients. CT is fast, accurate and cost effective in providing clinically useful information in a single examination. A recent study showed that integration of high resolution CT scanning into the early diagnostic protocol markedly reduces the length of stay in the trauma room and facilitates rapid therapeutic intervention.6

In order to provide improved accessibility to CT for the trauma patients, a 16-slice multi-detector computed tomography (MDCT) was installed in the emergency department (ED) of Prince of Wales Hospital (PWH) of Hong Kong in December 2004. The CT room is less than 15 m from the doors of the trauma resuscitation rooms within the ED. The ED CT scanner is available for the investigation of the suspected major trauma patient 24 h per day. The scanner is for ED use for the majority of the working week (70%) and outwith office hours, whereas for 30% of the working week it is primarily used for oncology work. However, even within these sessions, a suspected major trauma case will take priority over elective scanning.

The objectives of this study were to evaluate the impact of the CT scanner within the ED on trauma patient management and to compare the utilisation patterns of trauma CT before and after the installation of the EDCT.

Section snippets

Methods

This is a retrospective study using high quality data collected prospectively for an administrative trauma registry in the ED at this hospital. Data for the trauma registry is collected prospectively by a specialist trauma nurse coordinator who maintains a specific computerised trauma database.12 This database is used for monthly trauma audit and feedback to the hospital. The Prince of Wales Hospital (PWH) is a regional trauma centre and university teaching hospital located in Shatin, in the

Results

Of a total of 428 trauma cases, 226 and 202 were included before and after the installation of EDCT, respectively. 111 (49.1%) patients underwent CT scanning before EDCT was introduced compared with 110 (54.5%) afterwards. There were no statistically significant differences in age, injury severity scores or revised trauma scores between the two groups. Table 1 shows the comparison of outcomes both before and after the installation of EDCT. The proportion of trauma patients requiring early CT

Discussion

The CT scanner was developed in 1972 by Hounsfield and refined further by Ledley in 1973.8, 11 CT has had a major impact on many areas of medical care, especially trauma management. Clinical examination of trauma patients can be of limited use, particularly in the immediate period following injury when consciousness may be impaired. Immediate and accurate interpretation of the CT scan remains critical for surgical and clinical management decision making. In our hospital, radiologists report

Conclusion

After installation of the EDCT, more trauma patients had diagnostic CT scanning before definitive care and scans were done sooner. There was no significant increase in the number of unnecessary scans. To further decrease the time required for CT, the physical integration of EDCT into the trauma room would be desirable.

Conflict of interest statement

The authors report that there are no financial and personal relationships with other people, or organisations, that could inappropriately influence their work within 3 years of the beginning this study.

Acknowledgments

The authors thank all the medical and nursing staff of the Emergency Department and the Department of Diagnostic Radiology & Organ Imaging of the Prince of Wales Hospital for their help with this study.

References (12)

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