Accuracy of pre-hospital trauma notification calls.

STUDY OBJECTIVE: The aim of this study is to determine the accuracy of pre-hospital trauma notifications and the effects of inaccurate information on trauma triage. METHODS: This study was conducted at a level-1 trauma center over a two-year period. Data was collected from pre-notification forms on trauma activations that arrived to the emergency department via ambulance. Trauma activations with pre-notification were compared to those without notification and pre-notification forms were assessed for accuracy and completeness. RESULTS: A total of 2186 trauma activations were included in the study, 1572 (71.9%) had pre-notifications, 614 (28.1%) did not and were initially under-triaged. Pre-notification forms were completed for 1505 (95.7%) patients, of which EMS provided incomplete/inaccurate information for 1204 (80%) patients and complete/accurate information for 301 (20%) patients. Missing GCS/AVPU score (1099, 91.3%), wrong age (357, 29.6%), and missing vitals (303, 25.2%) were the main problems. Missing/wrong information resulted in trauma tier over-activation in 25 (2.1%) patients and under-activation in 20 (1.7%) patients. Under-triaged patients were predominantly male (18, 90%), sustained a fall (9, 45%), transported by BLS EMS teams (12, 60%), and arrived on a weekday (13, 65%) during the time period of 11 pm-7 am (9, 45%). A total of 13 (65%) required emergent intubation, 2 (10%) required massive transfusion activation, 7 (35%) were admitted to ICU, 3 (15%) were admitted directly to the OR, and 1 (15%) died. CONCLUSION: EMS crews frequently provide inaccurate pre-hospital information or do not provide any pre-hospital notification at all, which results in over/under triage of trauma patients.

Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors.

PURPOSE: The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented. METHODS: A retrospective review of CT imaging performed during trauma assessment at an urban level 1 trauma center was conducted. Prospectively documented incidental findings over a 6-month period were recorded. The frequency of incidental findings and follow-up referrals were analyzed. Mann-Whitney non-parametric test and Fisher's exact test were used to compare patients with and without incidental findings, and logistic regression was performed to identify independent risk factors. RESULTS: Of the 1573 CT scans performed, 478 (30.4%) revealed incidental findings. The abdomen/pelvis had the highest rate of incidental findings (61.7%). Of the 416 patients, 295 (70.9%) had a total of 858 incidental findings, with an average of 3 findings per patient. Follow-up was required for 24 (2.8%) incidental findings, and admission/immediate intervention was required for 6 (0.7%) findings. Only 12 (1.4%) incidental findings were documented in the discharge note. Increasing age (p < 0.001), a higher body mass index (BMI) (p = 0.015), and receiving a pan-CT (p < 0.001) increased the odds of having an incidental finding. CONCLUSION: A large percentage of trauma patients have incidental findings. Therefore, better documentation and follow-up are needed to determine the long-term outcomes of patients with clinically relevant incidental findings.

Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences?

STUDY OBJECTIVE: The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost. METHODS: A 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test. RESULTS: There were a total of 220 patients in the pre-pan-scan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the emergency department by 68.2 minutes (95% confidence interval [CI], -134.4 to -2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI, -2519 to -411). In contrast, fixed computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, -271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period. CONCLUSION: Although there are advantages to whole-body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol.