Diagnostic Yields, Charges, and Radiation Dose of Chest Imaging in Blunt Trauma Evaluations. (June 2014)

• Record Type: Journal Article
• Authors: Rodriguez, Robert M.; Baumann, Brigitte M.; Raja, Ali S.; Langdorf, Mark I.; Anglin, Deirdre; Bradley, Richard N.; Medak, Anthony J.; Mower, William R.; Hendey, Gregory W.; Gratton, Matthew
• Is Part Of: Academic emergency medicine. Volume 21:Number 6(2014:Jun.)
• Page Start: 644
• Page End: 650
• Publication Date: 2014-06
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12396
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" id="acem12396-abs-0001"> <title>Abstract</title> <sec id="acem12396-sec-0001" sec-type="section"> <title>Background</title> <p>Chest radiography (CXR) is the most common imaging in adult blunt trauma patient evaluation. Knowledge of the yields, attendant costs, and radiation doses delivered may guide effective chest imaging utilization.</p> </sec> <sec id="acem12396-sec-0002" sec-type="section"> <title>Objectives</title> <p>The objectives were to determine the diagnostic yields of blunt trauma chest imaging (CXR and chest computed tomography [CT]), to estimate charges and radiation exposure per injury identified, and to delineate assessment points in blunt trauma evaluation at which decision instruments for selective chest imaging would have the greatest effect.</p> </sec> <sec id="acem12396-sec-0003" sec-type="section"> <title>Methods</title> <p>From December 2009 to January 2012, we enrolled patients older than 14 years who received CXR during blunt trauma evaluations at nine U.S. Level I trauma centers in this prospective, observational study. Thoracic injury seen on chest imaging and clinical significance of the injury were defined by a trauma expert panel. Yields of imaging were calculated, as well as mean charges and effective radiation dose (ERD) per injury.</p> </sec> <sec id="acem12396-sec-0004" sec-type="section"> <title>Results</title> <p>Of 9, 905 enrolled patients, 55.4% had CXR alone, 42.0% had both CXR and CT, and 2.6% had CT alone. The yields for detecting thoracic injury were CXR 8.4% (95% confidence intervals [CIs]) = 7.8% to 8.9%), chest CT 28.8% (95% CI = 27.5% to 30.2%), and chest CT after normal CXR 15.0% (95% CI = 13.9% to 16.2%). The mean charges and ERD (millisievert [mSv]) per injury diagnosis of CXR, chest CT, and chest CT after normal CXR were $3, 845 (0.24 mSv), $10, 597 (30.9 mSv), and $20, 347 (59.3 mSv), respectively. The mean charges and ERD per clinically major thoracic injury diagnosis on chest CT after normal CXR were $203, 467 and 593 mSv.</p> </sec> <sec id="acem12396-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Despite greater diagnostic yield, chest CT entails substantially higher charges and radiation dose per injury diagnosed, especially when performed after a normal CXR. Selective chest imaging decision instruments should identify patients who require no chest imaging and patients who may benefit from chest CT after a normal CXR.</p> </sec> </abstract>