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An assessment of repeat computed tomography utilization in the emergency department in the setting of blunt trauma

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Abstract

Purpose

Computed tomography (CT) is a standard imaging modality utilized during the evaluation of trauma patients in the emergency department (ED). However, while it is common to utilize intravenous (IV) contrast as an adjunct, the use of multiple CT scans and how it impacts patient flow can lead to changes in patient management. Our objectives are to assess length of stay (LOS) and rates of acute kidney injury (AKI), when two CT scans of the abdomen/pelvis are performed compared to one CT scan.

Methods

Data of trauma hospital encounters were retrospectively collected during a 5-year period at a large, level 1 trauma center. Encounters were categorized into patients who received one or two CT scans of the abdomen/pelvis, as well as if they had received IV contrast or not. CT scan reads were extracted from chart records, and groups were compared.

Results

Of 5787 patient encounters, 5335 (93.4%) received IV contrast and 75 (1.3%) received two CT scans. Lower rates of AKI were associated with IV contrast (2.5 vs 12.5%). Receiving two CT scans was associated with increased rates of AKI (20.0 vs 3.0%; p < 0.0001), ICU admissions (88.0 vs 25.1%; p < 0.0001), and hospital LOS (21.9 vs 1.4 days; p < 0.0001). Of the repeat CT scans, 59.4% demonstrated no significant difference and did not require blood products or the operating room.

Conclusion

Two CT scans performed during blunt trauma encounters demonstrated mixed benefit and were associated with an increased hospital LOS. Additionally, IV contrast was associated with lower rates of AKI.

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Authors and Affiliations

  1. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Michael J. Burla, Jeffrey S. Ditkoff & David A. Berger

  2. Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    Michael J. Burla, Judith Boura, Lihua Qu, Jeffrey S. Ditkoff & David A. Berger

Authors
  1. Michael J. Burla
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  2. Judith Boura
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Corresponding author

Correspondence to Michael J. Burla.

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This study was approved by our hospital’s institutional review board.

Conflict of interest

The authors declare that they have no conflict of interest.

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Burla, M.J., Boura, J., Qu, L. et al. An assessment of repeat computed tomography utilization in the emergency department in the setting of blunt trauma. Emerg Radiol 25, 499–504 (2018). https://doi.org/10.1007/s10140-018-1614-y

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  • DOI: https://doi.org/10.1007/s10140-018-1614-y

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