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Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre
  1. Shahram Paydar1,2,
  2. Armin Ahmadi3,
  3. Behnam Dalfardi1,3,
  4. Alireza Shakibafard1,4,
  5. Hamidreza Abbasi1,2,
  6. Shahram Bolandparvaz1,2
  1. 1Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
  3. 3Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
  4. 4Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
  1. Correspondence to Dr Behnam Dalfardi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz 71448-33515, Iran; Dalfardibeh{at}gmail.com

Abstract

Introduction Cervical spine, thoracic and pelvic fractures are the main causes of devastation in patients who have suffered blunt trauma. Radiographic imaging plays an important role in diagnosing such injuries. Nevertheless, the present dominant approach, the routine use of X-ray studies, seems to have no cost-benefit justification for healthcare systems.

Methods This prospective cross-sectional study was performed over a 3-month period. During the determined time frame, all haemodynamically stable, high-energy blunt trauma patients were included. Based on the predefined criteria, selective radiographic images of the neck, chest and pelvis were obtained. Patients were followed during their hospital stay and for a 2-week period after discharge.

Results 1002 cases were included in the final survey. 247/1002 (24.6%) cervical radiographic images, 500/1002 (49.9%) CXRs and 171/1002 (17%) pelvic radiographic images of the patients were taken on the first day of hospital admission. New X-ray images required during the patients’ hospital stay resulted in 5/1002 (0.4%) cervical, 4/1002 (0.3%) chest and 8/1002 (0.7%) pelvic radiographies. In the 2-week period after discharge, 4/1002 cases (0.3%) needed to repeat neck radiography. Overall, 697.44 mSv X-ray radiation was potentially prevented and US$426 450 were potentially saved.

Conclusions Selective radiographic imaging of the neck, chest and pelvis together with a precise history-taking and physical examination in cases of high-energy blunt trauma could eliminate unnecessary costs to patients and healthcare systems, and significantly save resources.

  • Cost Effectiveness
  • Diagnosis

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