# CT Utilisation in Emergency Department (ED) Assessment of Patients With Suspected Polytrauma: Impact of a Dedicated Trauma Surgical Team

## TL;DR

A dedicated trauma surgical team in the emergency department led to more CT scans for suspected polytrauma patients, but without finding more injuries or improving scan results.

## Contribution

This study shows how introducing a trauma surgical unit affects CT scan use and outcomes in polytrauma patients.

## Key findings

- More CT scans were performed in the intervention group, especially for chest, abdomen, and pelvis.
- There was no significant increase in positive scan results despite more scans.
- The intervention group had more incidental findings and longer scan reporting times.

## Abstract

We aimed to assess the impact of introduction of a dedicated trauma surgical unit (TSU) on CT utilisation for polytrauma in the Emergency Department (ED).

Single centre retrospective cohort study comparing adult patients undergoing CT for polytrauma following TSU introduction (Intervention group, n = 617) to a historical Baseline group (n = 257) over a matched time period. Patient impact, including initial clinical assessment, injuries, radiation exposure, incidental findings, ED disposition, and impact on radiology services were compared with Mann–Whitney and Fisher's exact tests.

Intervention patients were more likely to be examined by ED physicians (96.7% vs. 91.1%, p = 0.001) prior to CT. There was greater documented clinical suspicion for chest and abdominal injuries, with increased WBCT utilisation for Intervention (Baseline 17.1% vs. 47.8%, p < 0.05), with no significant increase in positive scans by region. More CT chest (Intervention 38.4% vs. Baseline 14.8%, p < 0.05), CT abdomen (42.6% vs. 12.6%, p < 0.005) and CT pelvis (46.1% vs. 16%, p < 0.001) was performed even with low documented clinical suspicion, with no significant increase in positive findings. The intervention group returned for more additional scans (12.48% vs. Baseline 5.45%), had more incidental findings (23.66% vs. 15.18%), and were more likely to be admitted for observation (21.7% vs. 14%), all p < 0.05. Time to scan and total CT reporting time were significantly longer for Intervention.

Introduction of a TSU was associated in a shift towards increased CT utilisation, with no increase in scan yield, increased incidental findings and impacts on Radiology workflow.