Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences?

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• 作者：Melissa K. James ; PhD^a ; ^{mjames3@jhmc.org} ; Sebastian D. Schubl ; MD^a ; ^b ; ^{sschubl@gmail.com} ; Michael P. Francois ; BS^c ; ^{mikefrancois3@gmail.com} ; Geoffrey K. Doughlin ; MD^a ; ^d ; ^{gdoughli@jhmc.org} ; Shi-Wen Lee ; DO^d ; ^{slee@jhmc.org}
• 刊名：The American Journal of Emergency Medicine
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：35
• 期：1
• 页码：13-19
• 全文大小：241 K
• 卷排序：35

文摘

The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost.MethodsA 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test.ResultsThere were a total of 220 patients in the pre–pan-scan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the emergency department by 68.2 minutes (95% confidence interval [CI], −134.4 to −2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI, −2519 to −411). In contrast, fixed computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, −271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period.ConclusionAlthough there are advantages to whole-body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol.