Repeat imaging in trauma transfers: a retrospective analysis of computed tomography scans repeated upon arrival to a Level I trauma center.

BACKGROUND: The repetition of computed tomography (CT) imaging in caring for injured patients transferred between institutions is common, but it is not well studied. Our objective is to quantify and describe the characteristics associated with repeating chest and abdominal CT images for patients transferred to trauma centers and to determine whether repeat imaging leads to delays in definitive care or disparate outcomes.

METHODS: This is a retrospective review of adult, blunt trauma patients transferred to two Level I trauma centers between January 2004 and May 2008 who underwent CT imaging of the chest, abdomen, or both.

RESULTS: 60% of patients had at least one study repeated upon arrival to the trauma center. Variables associated with repeat imaging include Injury Severity Scores between 24 and 33 versus <15 (odds radio [OR], 1.6; 95% confidence interval [CI], 1.05-2.4), transfer to University of North Carolina (OR, 1.5; 95% CI, 1.01-2.2), transport by helicopter (OR, 1.6; 95% CI, 1.2-2.2), transfer in any year before 2008 (OR, 2.4; 95% CI, 1.6-3.6 for 2007; OR, 3.4; 95% CI, 2.2-5.3 for 2006; OR, 3.0; 95% CI, 1.8-5.0 for 2005; OR, 2.8; 95% CI, 1.7-4.7 for 2004), and triage alert level higher than the least severe level III (OR, 1.6; 95% CI, 1.01-2.7 for level II; OR, 2.2; 95% CI, 1.2-4.1 for level I). In adjusted models, there was no evidence that repeat imaging neither shortened the total time to definitive care nor altered patient outcomes.

CONCLUSIONS: Injured patients often undergo imaging that gets repeated, adding cost and radiation exposure while not significantly altering outcomes. The current policy push to digitize medical records must include provisions for the interoperability and use of imaging software.

LEVEL OF EVIDENCE: III, therapeutic study.