Declining trend in the use of repeat computed tomography for trauma patients admitted to a level i trauma center for traffic-related injuries

摘要

Objective: To evaluate the trend in utilization of repeat (i.e. ≥2) computed tomography (CT) and to compare utilization patterns across body regions for trauma patients admitted to a level I trauma center for traffic-related injuries (TRI). Materials and Methods: We linked the Harborview Medical Center trauma registry (1996-2010) to the billing department data. We extracted the following variables: type and frequency of CTs performed, age, gender, race/ethnicity, insurance status, injury mechanism and severity, length of hospitalization, intensive care unit (ICU) admission and final disposition. TRIs were defined as motor vehicle collisions, motorcycle, bicycle and pedestrian-related injuries. Logistic regression was used to evaluate the association between utilization of different body region repeat (i.e. ≥2) CTs and year of admission, adjusting for patient and injury-related characteristics that could influence utilization patterns. Results: A total of 28,431 patients were admitted for TRIs over the study period and 9499 (33%) received repeat CTs. From 1996 to 2010, the proportion of patients receiving repeat CTs decreased by 33%. Relative to 2000 and adjusting for other covariates, patients with TRIs admitted in 2010 had significantly lower odds of undergoing repeat head (OR = 0.61; 95% CI: 0.49-0.76), pelvis (OR = 0.37; 95% CI: 0.27-0.52), cervical spine (OR = 0.23; 95% CI: 0.12-0.43), and maxillofacial CTs (OR = 0.24; 95% CI: 0.10-0.57). However, they had higher odds of receiving repeat thoracic CTs (OR = 1.86; 95% CI: 1.02-3.38). Conclusion: A significant decrease in the utilization of repeat CTs was observed in trauma patients presenting with traffic-related injuries over a 15-year period.