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Repeat Spine Imaging in Transferred Emergency Department Patients

Bible, Jesse E. MD; Kadakia, Rishin J. MD; Kay, Harrison F. BS; Zhang, Chi E. BA; Casimir, Geoffrey E. BA; Devin, Clinton J. MD

doi: 10.1097/BRS.0000000000000137
Diagnostics
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Study Design. Retrospective study.

Objective. Assess frequency of repeat spine imaging in patients transferred with known spine injuries from outside hospital (OSH) to tertiary receiving institution (RI).

Summary of Background Data. Unnecessary repeat imaging after transfer has started to become a recognized problem with the obvious issues related to repeat imaging along with potential for iatrogenic injury with movement of patients with spine problems.

Methods. Consecutive adult patients presenting to a single 1-level trauma center with spine injuries during a 51-month period were reviewed (n = 4500), resulting in 1427 patients transferred from OSH emergency department. All imaging and radiology reports from the OSH were reviewed, as well as studies performed at RI. A repeat was the same imaging modality used on the same spine region as OSH imaging.

Results. The overall rate of repeat spine imaging for both OSH imaging sent and not sent was 23%, and 6% if repeat spine imaging via traumagram (partial/full-body computed tomography [CT]) was excluded as a repeat. The overall rate of repeat CT was 29% (7% dedicated spine CT scans and 22% part of nondedicated spine CT scan).

An observation of only those patients with OSH imaging that was sent and viewable revealed that 23% underwent repeat spine imaging with 23% undergoing repeat spine CT and 41% repeat magnetic resonance imaging.

In those patients with sent and viewable OSH imaging, a lack of reconstructions prompted 14% of repeats, whereas inadequate visualization of injury site prompted 8%. In only 8% of the repeats did it change management or provide necessary surgical information.

Conclusion. This study is the first to investigate the frequency of repeat spine imaging in transfers with known spine injuries and found a substantially high rate of repeat spine CT with minimal alteration in care. Potential solutions include only performing scans at the OSH necessary to establish a diagnosis requiring transfer and improving communication between OSH and RI physicians.

Level of Evidence: 4

This study is the first to investigate the frequency of repeat spine imaging in transfers with known spine injuries and found a substantially high rate of repeat spine computed tomography with minimal alteration in care as a result of the repeat imaging. Potential solutions include only performing scans at the outside hospital (OSH) necessary to establish a diagnosis requiring transfer and improving communication between OSH and receiving institution physician.

From the Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine, Nashville, TN.

Address correspondence and reprint requests to Jesse E. Bible, MD, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774; E-mail: jesse.bible@vanderbilt.edu

Acknowledgment date: September 10, 2013. First revision date: October 15, 2013. Second revision date: November 8, 2013. Acceptance date: November 11, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

© 2014 by Lippincott Williams & Wilkins