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CT scan and conventional x-ray in multiple injured patient care: diagnostic strategies and outcomes analysed from the TraumaRegister DGU®

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the current practice regarding the prevalence and sequence of x-ray and CT scan in diagnostic algorithms for multiple injured patients.

Methods

All primarily treated patients with ISS ≥ 9 were selected from the TraumaRegister DGU® (years 2008–2015; n = 109,257). Four subgroups of diagnostic algorithm were defined: CT only (group C; n = 63,763), CT before x-ray (group CX; n = 3711), x-ray followed by CT (group XC; n = 33,590), and x-ray only (group X, n = 8193). We analysed the type and sequence of diagnostic procedures and their association with hospital mortality and length-of-stay in the emergency room (ER-LOS).

Results

Predominant strategies were CT only (58.4%) and x-ray followed by CT (30.7%). Overall mortality was between 10 and 12% in all subgroups involving CT, and 6.6% in the x-ray only group. Expected mortality was within the 95% confidence of observed mortality except for the CX group (observed 10.0%; CI95 8.9–11.0; expected 11.1%). Mean / median length of stay in the emergency room was shortest in the CT only subgroup: (60 / 50 min). Prior x-ray diagnostic resulted in additional 3 min (group XC). The use of additional x-ray diagnostic decreased from 51.6% (in 2008) to 35.4% (in 2015).

Conclusions

ER-LOS is significantly affected by diagnostic pathway. CT scan alone accelerates ER-LOS, which however was not associated with lower mortality rates. Performing completive x-ray examinations after an initial CT scan seems not to deteriorate mortality rates.

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Funding

No funding was received for conducting this study. The authors have no relevant financial or non-financial interests to disclose.

Author information

Authors and Affiliations

  1. Department of Traumatology, Kliniken Dr. Erler, Nuremberg, Germany

    Roland Biber

  2. Department of Traumatology and Orthopaedics, Krankenhäuser Nürnberger Land, Lauf, Germany

    Carsten Kopschina

  3. Department of Orthopaedics and Traumatology, Klinikum Nürnberg, Nuremberg, Germany

    Maximilian Willauschus & Hermann Josef Bail

  4. Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany

    Rolf Lefering

  5. Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany

    Rolf Lefering

  6. Paracelsus Medical University, Nuremberg, Germany

    Roland Biber, Carsten Kopschina, Maximilian Willauschus & Hermann Josef Bail

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  1. Roland Biber
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the TraumaRegister DGU

Corresponding author

Correspondence to Roland Biber.

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Ethical standards

The study was performed in accordance with the publication guideline of the TraumaRegister DGU® and is registered as TR-DGU Project ID 2013–003. Since the study was a retrospective anonymised analysis, ethical approval was not required according to the regulations of the responsible regional medical association.

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Biber, R., Kopschina, C., Willauschus, M. et al. CT scan and conventional x-ray in multiple injured patient care: diagnostic strategies and outcomes analysed from the TraumaRegister DGU®. Eur J Trauma Emerg Surg 49, 1927–1932 (2023). https://doi.org/10.1007/s00068-022-02140-5

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  • DOI: https://doi.org/10.1007/s00068-022-02140-5

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