Abstract
Background: Multiple clinical practice guidelines recommend minimizing radiation in trauma patients but there is a knowledge gap on the importance of this problem for trauma transfers. We aimed to estimate the incidence of pretransfer and repeat posttransfer computed tomography (CT) overall and in patients with an indication for immediate transfer, to assess interhospital practice variation, to identify predictors, and to quantify the influence of pretransfer CT on time to transfer. Methods. We conducted a retrospective multicenter cohort study on patients transferred to major trauma centers from 2013 to 2019. Multilevel generalized linear regression was used to generate intraclass correlation coefficients (ICCs) to assess interhospital variation, multilevel logistic regression to generate odds ratios for each predictor, and geometric mean ratios to quantify the influence of CT on time to transfer. Results. Of 18,244 patients included, 8501 (47%) had a pretransfer CT and one-quarter (26%) had a repeat posttransfer CT. Interhospital variation was moderate for pretransfer CT (5%–66%, ICC 12.5%) and for repeat posttransfer CT (7%–44%, ICC 14.7%). Pretransfer imaging was more frequent in elders and in males and repeat posttransfer imaging decreased over the study period but was more frequent in patients transferred in from Level III/IV centers than nondesignated hospitals. Time to transfer was doubled in patients who had a pretransfer CT. Conclusions: Results suggest that pretransfer CT and repeat posttransfer CT are frequent and are subject to significant practice variation. In addition, pretransfer CT is associated with increased times to transfer though additional studies are needed to demonstrate causation. These results highlight potential opportunities to reduce low-value imaging for trauma transfers.
Original language | English |
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Journal | Academic Emergency Medicine |
DOIs | |
Publication status | Accepted/In press - 2022 |
Bibliographical note
Funding Information:This research was supported by the Canadian Institutes of Health Research (foundation grant 353374 and embedded clinician researcher [P.A.]). Drs Moore, Bérubé, Mercier, Archambault, and Lamontagne are recipients of a research salary Award from the Fonds de Recherche du Québec–Santé (FRQS). The funders had no role in developing this protocol. Funding information
Publisher Copyright:
© 2022 Society for Academic Emergency Medicine.
ASJC Scopus Subject Areas
- Emergency Medicine
PubMed: MeSH publication types
- Journal Article
- Multicenter Study
- Research Support, Non-U.S. Gov't