Triage tool helps cut unnecessary CT imaging for blunt trauma without worsening patient outcomes
Implementing a clinical triage tool can help to decrease the unnecessary use of CT imaging for blunt trauma, without worsening patient outcomes.
That’s according to a large, retrospective analysis of this intervention, detailed in RSNA’s Radiology. Multidetector CT can allow for fast and accurate diagnosis of head and neck injuries in patients with such injuries. However, this approach is often overused, possibly resulting in excess radiation exposure and healthcare costs, noted Chad Farris, MD, a neuroradiology fellow at Massachusetts General Hospital.
To address this challenge, Farris and colleagues explored the use of a novel triaging algorithm. The tool helps providers pinpoint which patients with trauma might benefit from MDCT at presentation, compared to those who are better off with simple clinical observation. Applying the algorithm to nearly 9,000 patients, treated between 2007 and 2013, researchers found measurable progress.
For instance, the number of patients who received MDCT head exams dropped from 64% down to 56% after the intervention, while CT of the cervical spine fell from almost 61% down to 49%.
“The implementation of clinical triaging algorithms significantly decreased the use of multidetector CT of the head and neck in patients with blunt trauma, without evidence that outcomes were adversely affected,” Farris, a former rad resident at Boston Medical Center, and colleagues concluded in the Jan. 12 study.
Meanwhile, MDCT imaging rates for angiography of the head and neck remained constant, the team found. However, they backed up claims of care quality by noting that hospital lengths of stay did not increase after the intervention, nor did LOS in the intensive care unit, or overall mortality in patients with blunt trauma.
In a corresponding editorial, experts called the analysis “admirable” for its large sample size, while advocating for further studies to validate clinical outcomes and optimize algorithm criteria.
“Implementing a diagnostic algorithm in routine clinical practice is often an inconsistent process and may be altered by variables such as attending physician preferences, time constraints, and medical-legal concerns,” wrote Felipe Munera and Adam Martin, both MDs with the Department of Radiology at the University of Miami Miller School of Medicine. “Farris et al. submit that they were unable to quantify how appropriately the algorithms were followed, but despite the likely imperfect adoption, a significant improvement in multidetector CT usage was nonetheless demonstrated in a real-world setting. Furthermore, clinical outcomes were not worsened for the cohort that received less imaging due to the algorithm. This strongly suggests that unnecessary examinations were avoided by implementing the triaging instructions.”
For more on the results, you can read the full investigation in Radiology here and the editorial here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.