In a study attempting to build consensus, they discovered philosophical differences between the trauma team and the emergency physician.
This is a prospective observational study in which 701 blunt trauma activations at LAC-USC were enrolled, with the EP and the trauma team each giving an opinion on which CT studies were necessary. The authors then reviewed which scans were obtained, sorted out the scans that were undesired by one or both physicians, and determined whether any injuries would be missed.
Bafflingly, 7% of the 2,804 scans obtained during the study period were deemed unnecessary by both the emergency physician and the trauma attending – yet were still performed. The remaining 794 undesired scans were desired by the trauma team but not the emergency physician. Their question – would anything of significance been missed if the scans had been more selectively ordered?
The answer is – yes and no. The trauma surgeon authors state yes, and justify that by saying that many of the abnormalities missed on CT required closer monitoring – just because none of the missed injuries deteriorated during the study period does not mean they were not significant. The emergency physician authors point to a 56% reduction in pan-scanning, the benefits of radiation and cost reductions, and hang their hats on the fact that none of the hypothetically missed injuries changed management.
So, who is right? Both, and neither, of course. Emergency physicians and trauma teams should work on developing evidence-based clinical decision rules to support selective scanning in blunt trauma – and then try this study again to see if they can generate results they can agree on.
Definitely a fun read.
As far as medical literature goes, of course.
“Selective Use of Computed Tomography Compared With Routine Whole Body Imaging in Patients With Blunt Trauma.”
www.ncbi.nlm.nih.gov/pubmed/21890237