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Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol

Authors


  • Stephen Asha, BSc MBBS, FACEM, Emergency Physician, Conjoint Lecturer; Kate Anne Curtis, RN PhD, Clinical Nurse Consultant, Post-doctoral Fellow in Trauma Care, Honorary Professorial Fellow; Nicole Grant, MBBS, Emergency Registrar; Colman Taylor, BPhEd MND, Research Fellow; Serigne Lo, AStat PhD, Biostatistician, Research Fellow; Richard Smart, MSc PhD, Radiation Safety Officer, Conjoint Lecturer; Katherine Compagnoni, BAppScMRT(DiagRad), Radiographer.

Dr Stephen Asha, Emergency Department, St George Hospital, Gray Street, Kogarah, NSW 2217, Australia. Email: stephen.asha@sesiahs.health.nsw.gov.au

Abstract

Objectives: To compare the proportion of patients exposed to a radiation dose in excess of 20 mSv, and to document missed injuries before and after the introduction of a panscan protocol for blunt trauma.

Methods: Data were collected retrospectively from our trauma database for 6 months before and after implementation of the protocol. All radiological studies performed during the initial patient assessment were identified. Radiation doses for each patient were calculated. Subgroup analyses were age ≤30 and >30 years, injury severity score (ISS) <16 and ≥16, and patient disposition as discharged from ED or admitted.

Results: There were 656 patients before and 624 after the introduction of the protocol. The proportion of patients exposed to a radiation dose >20 mSv increased by 8% (95% confidence interval [CI] 4–12), which equated to one extra person being exposed to >20 mSv for every 13 patients treated after the introduction of the protocol. The odds of receiving a radiation dose >20 mSv after the introduction of the protocol compared with the odds before were increased across all subgroups (≤30 years: odds ratio [OR] 2.7, 95% CI 1.3–5.8, P = 0.008; >30 years: OR 2.2, 95% CI 1.5–3.4, P < 0.001; ISS < 16: OR 2.4, 95% CI 1.5–3.9, P < 0.001; ISS ≥ 16: OR 2.0, 95% CI 1.0–3.7, P = 0.04; discharged home: OR 2.1, 95% CI 0.7–6.0, P = 0.17; admitted: OR 2.2, 95% CI 1.5–3.3, P < 0.001). There were six missed injuries before and four after.

Conclusions: Introduction of a panscan protocol increased the proportion of trauma patients receiving a radiation dose >20 mSv. This increased risk occurred regardless of age or injury severity.

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