Overuse of CT Scans for Blunt Trauma Cases in the Hospital Emergency Room

The results of a new study show that the use of chest Computed Tomography (CT) scans for blunt trauma cases arriving in hospital emergency-rooms could be safely reduced by at least one third.

The study was led by a physician at the University of California, San Francisco (UCSF; San Francisco, CA, USA) and included more than 11,000 patients ages 15 and older. The results of the study were published online, in the October 6, 2015, issue of the journal PLOS Medicine. The first part of the study included 6,002 patients, and the validation phase, an additional 5,475.

The researchers developed two checklists with criteria that physicians could use to identify patients with injuries that required CT imaging, and those that did not. One set included seven criteria such as abnormal chest X-ray scan, and a rapid deceleration mechanism. The second set of criteria excluded the deceleration mechanism. The rapid deceleration mechanism was defined as a fall from more than 6 m, or a motor vehicle accident while traveling at more than 64 km/hr. The results of the study showed that either set of criteria would enable identification of more than 99% of the major injuries in the study group. The results also showed that approximately 95% of all injuries would have been identified using the full set of criteria compared to 90% for the smaller set.

Study leader Robert Rodriguez, MD and professor of emergency medicine at UCSF, said, "CT scans deliver radiation dosages to the body that elevate cancer risk, especially in the young, and they are expensive, so we want to be sure to use them only when they are likely to provide a diagnostic benefit. Except for the chest X-ray, the clinical criteria we incorporated into the decision-making tools are simple, straightforward components of the routine trauma history and physical exam. Healthcare providers will not need to spend more time, money or effort to implement them."

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