TY - JOUR
T1 - CT scan and conventional x-ray in multiple injured patient care
T2 - diagnostic strategies and outcomes analysed from the TraumaRegister DGU®
AU - TraumaRegister DGU
AU - Biber, Roland
AU - Kopschina, Carsten
AU - Willauschus, Maximilian
AU - Bail, Hermann Josef
AU - Lefering, Rolf
N1 - © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - Humans
KW - X-Rays
KW - Retrospective Studies
KW - Tomography, X-Ray Computed/methods
KW - Emergency Service, Hospital
KW - Registries
KW - Injury Severity Score
KW - Length of Stay
KW - Germany/epidemiology
KW - Multiple Trauma/therapy
U2 - 10.1007/s00068-022-02140-5
DO - 10.1007/s00068-022-02140-5
M3 - Original Article
C2 - 36305903
SN - 1863-9933
VL - 49
SP - 1927
EP - 1932
JO - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
JF - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
IS - 4
ER -