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The Increasing Burden of Radiation Exposure in the Management of Trauma Patients

Inaba, Kenji MD; Branco, Bernardino C. MD; Lim, George BSc; Russell, Katie MD; Teixeira, Pedro G. R. MD; Lee, Kai PhD; Talving, Peep MD, PhD; Reddy, Sravanthi MD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: June 2011 - Volume 70 - Issue 6 - p 1366-1370
doi: 10.1097/TA.0b013e3181ebb4d4
Original Article

Background: As trauma care evolves, there has been increased reliance on imaging. The purpose of this study was to examine changes in trauma imaging and radiation exposure over time. Our hypothesis was that there has been an increased usage of imaging in the management of trauma patients without measurable improvements in outcomes.

Methods: A continuous series of injured patients admitted to a Level I trauma center during a 2-month period in 2002 was compared with the same period in 2007. All computed tomography (CT)s and plain radiographs performed for each patient were tabulated. Effective radiation dose estimates for each patient were then calculated. The outcome measures were length of stay, mortality, and missed injuries.

Results: The 495 patients in 2007 and 497 patients in 2002 demonstrated no significant differences in demographics, clinical data, or outcomes between groups. However, from 2002 to 2007, for blunt trauma, the mean CTs per patient increased significantly (2.1 ± 1.6 vs. 3.2 ± 2.0, p < 0.001), as did plain radiographs (8.8 ± 12.9 vs. 14.9 ± 17.0, p < 0.001). For penetrating trauma, roentgenogram usage increased significantly (4.2 ± 5.3 vs. 9.1 ± 14.4, p = 0.01) with a trend toward increased CTs (0.7 ± 1.1 vs.1.0 ± 1.6, p = 0.11). Total radiation dose estimates demonstrated significantly increased radiation exposure in 2007; blunt (11.5 ± 11.3 mSv vs. 20.7 ± 14.9 mSv, p < 0.05) and penetrating (2.9 ± 4.9 mSv vs. 5.4 ± 7.9 mSv, p < 0.05).

Conclusion: From 2002 to 2007, there was a significant increase in the use of CT and plain radiographs in the management of trauma patients, leading to significantly higher radiation exposure with no demonstrable improvements in the diagnosis of missed injuries, mortality, or length of stay.

From the Division of Trauma and Surgical Critical Care (K.I., B.C.B., G.L., P.G.R.T., P.T., D.D.), University of Southern California Medical Center, Los Angeles, California; Department of Surgery (K.R.), University of Utah, Salt Lake City, Utah; and Department of Radiology (K.L., S.R.), University of Southern California Medical Center, Los Angeles, California.

Submitted for publication March 9, 2010.

Accepted for publication June 7, 2010.

Presented at the 81st Annual Meeting of the Pacific Coast Surgical Association, February 13–16, 2010, Maui, HI.

Address for reprints: Kenji Inaba, MD, FRCSC, FACS, Division of Trauma and Surgical Critical Care, University of Southern California, 1200 North State Street, Room CL5100, Los Angeles, CA 90033-4525; email:

© 2011 Lippincott Williams & Wilkins, Inc.