CT scan and conventional x-ray in multiple injured patient care: diagnostic strategies and outcomes analysed from the TraumaRegister DGU®

TraumaRegister DGU

Research output: Contribution to journalOriginal Articlepeer-review

Abstract

PURPOSE: To evaluate the current practice regarding the prevalence and sequence of x-ray and CT scan in diagnostic algorithms for multiple injured patients.

METHODS: All primarily treated patients with ISS ≥ 9 were selected from the TraumaRegister DGU® (years 2008-2015; n = 109,257). Four subgroups of diagnostic algorithm were defined: CT only (group C; n = 63,763), CT before x-ray (group CX; n = 3711), x-ray followed by CT (group XC; n = 33,590), and x-ray only (group X, n = 8193). We analysed the type and sequence of diagnostic procedures and their association with hospital mortality and length-of-stay in the emergency room (ER-LOS).

RESULTS: Predominant strategies were CT only (58.4%) and x-ray followed by CT (30.7%). Overall mortality was between 10 and 12% in all subgroups involving CT, and 6.6% in the x-ray only group. Expected mortality was within the 95% confidence of observed mortality except for the CX group (observed 10.0%; CI95 8.9-11.0; expected 11.1%). Mean / median length of stay in the emergency room was shortest in the CT only subgroup: (60 / 50 min). Prior x-ray diagnostic resulted in additional 3 min (group XC). The use of additional x-ray diagnostic decreased from 51.6% (in 2008) to 35.4% (in 2015).

CONCLUSIONS: ER-LOS is significantly affected by diagnostic pathway. CT scan alone accelerates ER-LOS, which however was not associated with lower mortality rates. Performing completive x-ray examinations after an initial CT scan seems not to deteriorate mortality rates.

Original languageEnglish
Pages (from-to)1927-1932
Number of pages6
JournalEUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
Volume49
Issue number4
DOIs
Publication statusPublished - Aug 2023

Keywords

  • Humans
  • X-Rays
  • Retrospective Studies
  • Tomography, X-Ray Computed/methods
  • Emergency Service, Hospital
  • Registries
  • Injury Severity Score
  • Length of Stay
  • Germany/epidemiology
  • Multiple Trauma/therapy

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