An interesting article worthy of a literature review was recently discussed at our Journal Club. Posted below is a description of the article and key takeaways from our discussion.

“Evaluating our progress with trauma transfer imaging: repeat CT scans, incomplete imaging, and delayed definitive care”

The research article was published in the journal Emergency Radiology. The study aimed to evaluate the progress made in trauma transfer imaging by investigating repeat CT scans, incomplete imaging, and delayed definitive care. The researchers conducted a retrospective review of all tier 1 trauma patients transferred to their trauma center between May 2018 and April 2019. They compared patients who underwent CT imaging at the initial hospital (IH) with those who did not. The study identified several imaging inadequacies, including repeat CT scans, C-spine inadequacies, incomplete chest-abdomen-pelvis (CAP) imaging, and CAP CT without IV contrast.

The results of the study showed that obtaining CT imaging at the IH led to significantly prolonged IH time. Among patients who had IH imaging, a considerable number required repeat CT scans, had C-spine inadequacies, incomplete CAP imaging, or one or more imaging inadequacies. Most patients with imaging at the IH returned to the CT scan at the trauma center. The study concluded that there are continuing issues with IH CT imaging, which result in delays in definitive care and increased radiation exposure for patients.

The most important takeaway from our discussion was the importance of following ATLS to manage your trauma patients. ATLS trained EM physicians know that a potentially critical trauma patient needs to be resuscitated, receive FAST examination, and receive chest/pelvic xrays where applicable. Once completed, these patients should be transferred to centers where definitive trauma management (ie surgery) is available. Spending time to obtain CT imaging usually leads to a delay in care for the patient.