The impact of imaging: Does whole-body CT lead to longer hospital stays?

Patients who undergo whole-body computed tomography (WBCT) do not have a significantly longer length of stay (LOS) in the hospital than those who receive selective CT, according to a recent study published by Academic Radiology.

Jessica Chan, MD, department of radiology at the University of Utah in Salt Lake City, and colleagues noted that WBCT has become much more common in EDs in the last 20 years. However, the authors explained, this increase has sparked debates about the potential negative side effects of WBCT.

“The use of WBCT imaging in patients with blunt trauma in the ED remains controversial due to (1) the proliferation of potentially unnecessary imaging, (2) the associated risk of radiation exposure, (3) the added cost of the additional imaging, (4) the added time in the scanner, and (5) the expense of further workup of incidental findings,” the authors wrote.

Chan et al. explained that numerous studies on WBCT have been performed in Europe, but information directly from U.S. facilities was lacking, so they decided to dive a little deeper themselves. The team examined data from more than 2,000 patients who received care at their academic Level 1 trauma center from June 2011 to July 2013. All patients were over the age of 18 and had sustained blunt trauma. More than 14 percent of the patients underwent WBCT, and the remaining patients underwent selective CT.

Overall, the authors found “no statistically or clinically significant difference” in hospital LOS or discharge location.

WBCT patients had an average LOS that was less than one third of a day longer than patients who received selective imaging, a difference Chan and colleagues explained is minor.

WBCT patients were also more likely to be discharged to a nursing home instead of their own home compared to patients who received selective imaging, but again, the difference was “not statistically significant.”

The authors also tracked information on patient modality and LOS in the ICU, but they were unable to make any meaningful observations based on the data they collected.

“Of the entire cohort, only 79 patients (3.4 percent) died within 30 days precluding a meaningful 30-day mortality analysis,” the authors wrote. “Likewise, the distribution of the ICU LOS was significantly skewed, causing the analysis to be insufficiently powered due to the dominance of a small number of outliers.”