No do-overs: VPN cuts repeat CT imaging for transferred trauma patients

Image sharing networks established through a virtual private network (VPN) can cut the need for repeat imaging of transferred trauma patients, according to a study published online June 13 in the Journal of the American College of Radiology.

This was the experience of Harborview Medical Center in Seattle, which saw reduced use of CT for transfer patients relative to direct-admit patients following the creation of a regional VPN in 2005, explained Kevin J. Psoter, MPA, University of Washington, Seattle, and colleagues.

The authors explained that despite recommendations against the practice, approximately 50 percent of trauma patients undergo at least one CT study at a referring institution prior to transfer. This can cause delays, but the situation is further complicated by the fact that about one in five transferred patients have at least one CT scan repeated upon admission.

Harborview is the only level I adult and pediatric trauma center serving Washington State and parts of Montana, Idaho and Alaska, and as such, a large percentage of admissions are transfers. In an effort to cut down on repeat CT imaging, the hospital implemented a VPN in 2005 to allow participating hospitals to send and receive imaging files without the need for cumbersome and unreliable CDs. More than 120 facilities are connected to Harborview through the VPN, and others can use a cloud-based sharing system, explained Psoter and colleagues.

A retrospective study of Harborview’s trauma registry and billing data was conducted to discern the effect the network had on CT use in trauma patients. A total of 81,159 patients were admitted to the hospital from 1996 through 2010, 44 percent of whom were transfers.

“The utilization of head CT slightly increased from 1996 to 2005, with no significant difference between direct-admit and transfer patients,” wrote the authors. “Between 2005 and 2010, utilization remained relatively unchanged; however, significantly higher utilization rates were observed for direct-admit patients.” Even after adjusting for confounding variables, they observed similar patterns in pelvic, abdominal and thoracic CT use, with utilization rates greater for direct-admit patients compared with transfer patients following the launch of the VPN in 2005.

“The development of VPNs in regional trauma networks for direct and secure transfer of images from outside hospitals' PACS or scanners to receiving hospitals' PACS could prevent unnecessary repeat imaging, decrease radiation dose, and reduce the cost of imaging for transfer trauma patients,” wrote Psoter and colleagues.