We can all agree the advent of CT has improved our diagnostic capabilities, particularly in multi-system trauma. Few would challenge an assumption that outcomes are positively impacted by timely, accurate identification of clinically important pathology.
Unfortunately, the pendulum has swung so far in favor of CT in trauma, any intelligent reliance on clinical exam skills has been deprecated to obsolete. As such, the expected fallout includes increases in costs, radiation, and length-of-stay as the zero-miss culture creeps from multi-system trauma into the lightly injured. This has become such an issue the American College of Surgeons devoted one of five slots in their first Choosing Wisely Guidelines to reducing the use of the trauma “pan-scan”.
Hopefully, the culture change will happen none-to-soon, as this NHAMCS data review indicates – showing steady increases in CT use for both head and body over the 2007 to 2010 review period. Head CT increased from 9.6% to 11.6% of all injury-related encounters, while body CT increased from 5.5% to 8.1% – without any corresponding increase in positive findings. Yield for severe injury dropped from 4.9% to 3.4% on Head CT, along with a drop for body CT from 6.4% to 3.3%.
This is the NHAMCS probabilistic sample, of course, and it’s simply a coarse observational cohort without detailed clinical factors. However, I think the likelihood these observations accurately reflect reality is rather high.
Choose more wisely, please.
“Trends in Advanced Computed Tomography Use for Injured Patients in United States Emergency Departments: 2007–2010”
http://www.ncbi.nlm.nih.gov/pubmed/25996245