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Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes.

Abstract

BACKGROUND
Computed tomography (CT) of injured patients in the radiology department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow.
METHODS
A randomized trial compared the effect of locating a CT scanner in the trauma room versus the radiology department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI).
RESULTS
Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P < 0.001). Patient transfers and transports were reduced by more than half in the intervention group. For both multiple trauma (265 patients) and TBI (121) subgroups, differences in mortality and out-of-hospital days favoured the intervention group, but were not statistically significant.
CONCLUSION
A CT scanner located in the trauma room reduces the time to acquire CT images and improves workflow, but does not lead to substantial improvements in clinical outcomes in a general trauma population. Observed beneficial effects on outcomes in patients with multiple trauma or severe TBI were not statistically significant. Registration number: ISRCTN55332315 (http://www.controlled-trials.com).

Links

  • Publisher Full Text
  • Authors

    Saltzherr TP, Bakker FC, Beenen LF, Dijkgraaf MG, Reitsma JB, Goslings JC, REACT Study Group

    Source

    The British journal of surgery 99 Suppl 1: 2012 Jan pg 105-13

    MeSH

    Adult
    Female
    Humans
    Injury Severity Score
    Intensive Care
    Length of Stay
    Male
    Middle Aged
    Quality of Life
    Radiology Department, Hospital
    Time Factors
    Tomography, X-Ray Computed
    Trauma Centers
    Treatment Outcome
    Wounds and Injuries

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22441863