Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study

Alexa N Lucas¹, Erika Tay-Lasso², Danielle C Zezoff³, Nicole Fierro⁴, Navpreet K Dhillon⁴, Eric J Ley⁴, Jennifer Smith⁵, Sigrid Burruss⁶, Alden Dahan⁷, Arianne Johnson⁸, William Ganske⁸, Walter L Biffl⁹, Dunya Bayat⁹, Matthew Castelo⁹, Diane Wintz¹⁰, Kathryn B Schaffer¹⁰, Dennis J Zheng¹¹, Areti Tillou¹¹, Raul Coimbra¹², Rahul Tuli¹², Jarrett E Santorelli¹³, Brent Emigh¹⁴, Morgan Schellenberg¹⁴, Kenji Inaba¹⁴, Thomas K Duncan¹⁵, Graal Diaz¹⁵, Katharine A Kirby¹⁶, Jeffry Nahmias¹⁷

Affiliations

¹ Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
² Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA.
³ Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
⁴ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
⁶ Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
⁷ Riverside School of Medicine, University of California, Riverside, CA, USA.
⁸ Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
⁹ Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
¹⁰ Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
¹¹ Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
¹² Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA.
¹³ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
¹⁴ Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
¹⁵ Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
¹⁶ Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA.
¹⁷ Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA. jnahmias@hs.uci.edu.

PMID: 38150084
PMCID: PMC10830714
DOI: 10.1007/s10140-023-02195-w

Multicenter Study

Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study

Alexa N Lucas et al. Emerg Radiol. 2024 Feb.

. 2024 Feb;31(1):53-61.

doi: 10.1007/s10140-023-02195-w. Epub 2023 Dec 27.

Authors

Affiliations

¹ Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
² Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA.
³ Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
⁴ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
⁶ Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
⁷ Riverside School of Medicine, University of California, Riverside, CA, USA.
⁸ Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
⁹ Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
¹⁰ Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
¹¹ Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
¹² Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA.
¹³ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
¹⁴ Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
¹⁵ Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
¹⁶ Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA.
¹⁷ Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA. jnahmias@hs.uci.edu.

PMID: 38150084
PMCID: PMC10830714
DOI: 10.1007/s10140-023-02195-w

Abstract

Purpose: Following motor vehicle collisions (MVCs), patients often undergo extensive computed tomography (CT) imaging. However, pregnant trauma patients (PTPs) represent a unique population where the risk of fetal radiation may supersede the benefits of liberal CT imaging. This study sought to evaluate imaging practices for PTPs, hypothesizing variability in CT imaging among trauma centers. If demonstrated, this might suggest the need to develop specific guidelines to standardize practice.

Methods: A multicenter retrospective study (2016-2021) was performed at 12 Level-I/II trauma centers. Adult (≥18 years old) PTPs involved in MVCs were included, with no patients excluded. The primary outcome was the frequency of CT. Chi-square tests were used to compare categorical variables, and ANOVA was used to compare the means of normally distributed continuous variables.

Results: A total of 729 PTPs sustained MVCs (73% at high speed of ≥ 25 miles per hour). Most patients were mildly injured but a small variation of injury severity score (range 1.1-4.6, p < 0.001) among centers was observed. There was a variation of imaging rates for CT head (range 11.8-62.5%, p < 0.001), cervical spine (11.8-75%, p < 0.001), chest (4.4-50.2%, p < 0.001), and abdomen/pelvis (0-57.3%, p < 0.001). In high-speed MVCs, there was variation for CT head (12.5-64.3%, p < 0.001), cervical spine (16.7-75%, p < 0.001), chest (5.9-83.3%, p < 0.001), and abdomen/pelvis (0-60%, p < 0.001). There was no difference in mortality (0-2.9%, p =0.19).

Conclusion: Significant variability of CT imaging in PTPs after MVCs was demonstrated across 12 trauma centers, supporting the need for standardization of CT imaging for PTPs to reduce unnecessary radiation exposure while ensuring optimal injury identification is achieved.

Keywords: Computed tomography; Fetus radiation; Imaging; Pregnancy; Pregnant trauma.

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Conflict of interest statement

The authors declare no competing interests.

References

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Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study

Affiliations

Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources