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Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients

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Abstract

Background

During the initial assessment of patients with potential severe injuries, radiological examinations are performed in order to rapidly diagnose clinically relevant injuries. Previous studies have shown that performing these examinations routinely is not always necessary and that trauma patients are exposed to substantial radiation doses. The aim of this study was to assess the amount and findings of radiological examinations during the initial assessment of trauma patients and to determine the radiation doses to which these patients are exposed to.

Methods

We analyzed the 1124 patients included in a randomized trial. All radiological examinations during the initial assessment (i.e., primary and secondary survey) were assessed. The examination results were categorized as positive findings (i.e., (suspicion for) traumatic injury) and normal findings. The effective radiation doses for the examinations were calculated separately for each patient.

Results

Eight hundred and three patients were male (71 %), median age was 38 years, and 1079 patients sustained blunt trauma (96 %). During initial assessment, almost 3900 X-rays were performed, of which 25.4 % showed positive findings. FAST of the abdomen was performed in 989 patients (88 %), with positive findings in 10.6 %. Additional CT scanning of specific body regions was performed 1890 times in 813 patients (72.1 %), of which approximately 43.4 % revealed positive findings. Hemodynamically stable patients showed more normal findings on the radiographic studies than unstable patients. The mean radiation doses for the total population was 8.46 mSv (±7.7) and for polytraumatized patients (ISS ≥ 16) 14.3 mSv (±9.5).

Conclusion

Radiological diagnostics during initial assessment of trauma patients show a high rate of normal findings in our trauma system. The radiation doses to which trauma patients are exposed are considerable. Considering that the majority of the injured patients are hemodynamically stable, we suggest more selective use of X-ray and CT scanning.

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Author information

Authors and Affiliations

  1. Department of Trauma Surgery, VU University Medical Centre, Room 7F-002, PO Box 7057, NL - 1007 MB, Amsterdam, The Netherlands

    G. F. Giannakopoulos, F. W. Bloemers & F. C. Bakker

  2. Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands

    T. P. Saltzherr & J. C. Goslings

  3. Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands

    L. F. M. Beenen & G. J. Streekstra

  4. Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands

    G. J. Streekstra

  5. Department of Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands

    J. B. Reitsma

Authors
  1. G. F. Giannakopoulos
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  2. T. P. Saltzherr
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  3. L. F. M. Beenen
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  4. G. J. Streekstra
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  5. J. B. Reitsma
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  6. F. W. Bloemers
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  7. J. C. Goslings
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  8. F. C. Bakker
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Consortia

on behalf of the REACT study group

  • P. H. P. Fung Kon Jin
  • , K. J. Ponsen
  • , J. S. K. Luitse
  • , C. P. Henny
  • , M. G. W. Dijkgraaf
  •  & P. M. M. Bossuyt

Corresponding author

Correspondence to G. F. Giannakopoulos.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was conducted as part of the prospective REACT trial, which was funded by an unrestricted grant from ZonMw, the Netherlands organization for health research and development (grant number 3920.0005).

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Giannakopoulos, G.F., Saltzherr, T.P., Beenen, L.F.M. et al. Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients. Langenbecks Arch Surg 402, 159–165 (2017). https://doi.org/10.1007/s00423-016-1515-z

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  • DOI: https://doi.org/10.1007/s00423-016-1515-z

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