Authors: Aman Banerjee MD, David Bronson MD, Debra Allen BSN, Patricia A Wilczewski RN, Robert Ferguson MD, Jeffrey A Claridge MD, MS
Introduction: The practice of repeating computed tomography (re-CT) is common among trauma patients transferred between hospitals incurring additional cost and radiation exposure. This study sought to evaluate the effectiveness of implementing modern cloud-based technology (lifeIMAGE®) across a regional trauma system to reduce the incidence of re-CT imaging.
Methods: This is a prospective interventional study to evaluate outcomes after implementation of lifeIMAGE® in January 2012. Key outcomes were rates of CT imaging, including the rates and costs of re-CT from January 2009 through December 2012.
Results: There were 1081 trauma patients transferred from participating hospitals during the study period (657 patients before and 425 patients after implementation) with the overall re-CT rate of 20.5%. Rates of any CT imaging at referring hospitals decreased (62% vs. 55%, p < 0.05) and also decreased at the accepting regional level 1 center (58% vs. 52%, p < 0.05) following system implementation. There were 639 (59%) patients who had CT imaging performed prior to transfer (404 patients before and 235 patients after implementation). Of these patients the overall re-CT rate decreased from 38.4% to 28.1% (p = 0.01). Rates of re-CT head (21% vs. 11%, p = 0.002), chest (7% vs. 3%, p = 0.05), and abdomen and pelvis (12% vs. 5%, p = 0.007) were significantly reduced following system implementation. The cost of repeat imaging per patient was significantly lower following system implementation (mean charges of $1,046 vs. $589, p < 0.001). These results were more pronounced in a subgroup of patients with an ISS > 14 with a reduction in overall re-CT from 51% to 30% (p = 0.03). Conclusion: The implementation of modern cloud-based technology across the regional trauma system resulted in significant reductions in re-CT imaging and cost.