Trauma CT imaging at non-trauma centers often inadequate

Subpar quality in trauma CT images acquired in non-trauma care settings hampers accurate radiological interpretation, suggesting that other-than-imaging assessments are best until these patients are sent to trauma centers, according to a study published online April 18 in the Journal of Trauma and Acute Care Surgery.

Morgan Bonds, MD, and colleagues at the University of Oklahoma prospectively enrolled 235 consecutive patients who were transferred from any non-trauma center (NTC) to OU Medical Center, the school’s affiliated level-1 trauma center, over an eight-month period.

Of the 235 consecutive patients with a complete dataset were included, 203 (86.4 percent) had a CT scan performed at an NTC.

Comparing images and interpretations from their center and the NTC cohort in a blinded fashion, the team found that interpretation by their center’s trauma radiologist using NTC images missed injuries in 49 percent of the patients.

An eye-catching 90 percent of these missed injuries were deemed clinically significant, meaning “the injury would have altered patient care had they been identified,” the authors write.

When the same body region was imaged at the trauma center, 54 percent had missed injuries, of which 76 percent were deemed significant.

Additional imaging was obtained at the trauma center in 76 percent of patients with outside CT (154 of 203), the authors report.

The primary reasons to repeat imaging were inadequacy of outside CTs for patient workup based on mechanism of injury (76 percent) and technical inadequacy of outside images (31 percent).

“This study demonstrates inaccuracy in the interpretation of NTC images, which can lead to inappropriate management of trauma patients,” Bonds et al. write. “Parameters other than imaging need to be utilized to identify patients requiring a higher level of care.”