Implementation of a cost-saving algorithm for pelvic radiographs in blunt trauma patients

Andrew Barleben, Fariba Jafari, John S Rose, Matthew Dolich, Darren Malinoski, Michael Lekawa, David Hoyt, Marianne Cinat

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND:: In a previous retrospective study, we demonstrated that pelvic radiographs (PXRs) in the evaluation of blunt trauma patients undergoing abdominal computed tomographic (CT) scanning have limited utility in the absence of hemodynamic instability and significant physical findings. The purpose of this study was to prospectively validate an algorithm defining indications for PXR in blunt trauma patients in the emergency department. METHODS:: We performed a prospective observational study of consecutive blunt trauma patients over 6 months at a single Level 1 trauma center. The trauma faculty agreed to implement an algorithm of obtaining PXRs in patients undergoing abdominal CT scanning only if a specific set of criteria were met: systolic blood pressure <90 mm Hg, hemoglobin <8 mg/dL, a drop in Hgb of more than 3 mg/dL while in the trauma bay, or significant physical examination findings. The algorithm could be overridden at the discretion of the attending physician. RESULTS:: Nine hundred ninety-five consecutive blunt trauma patients whose evaluation was to include an abdominal CT scan were included in the study. Only 54 patients (6%) received a PXR. Fifty-six indications for PXR were provided: 35 (63%) severe pelvic pain, 14 (25%) proximal fractures, 3 (5%) hip dislocations, and only 4 (7%) had unexplained hypotension. No adverse events or delays in care occurred such as hypotension in the CT scanner or a delay in contacting interventional radiology, blood transfusion, or application of a pelvic binder. The algorithm selected PXR for patients who were more likely to have a pelvic fracture (33% vs. 4.5%, p < 0.001), hip dislocation (7.4% vs. 0.1%, p < 0.001), femur fracture (22.2% vs. 2.7%, p < 0.001), and to require blood transfusion (11.1% vs. 1.9%, p < 0.001). Implementation of this algorithm resulted in a decrease in charges of >$226, 000 in 6 months. CONCLUSION:: When objective evaluation of the abdomen is to be obtained via CT scanning, PXR in the emergency department is obsolete in the absence of hemodynamic instability and significant physical examination findings. Implementation of a selective algorithm in this patient population can result in significant cost savings without adverse patient outcomes.

Original languageEnglish (US)
Pages (from-to)582-584
Number of pages3
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number3
DOIs
StatePublished - Sep 2011

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Costs and Cost Analysis
Wounds and Injuries
Hospital Emergency Service
Hemodynamics
Blood Pressure
Cost Savings
Trauma Centers
Abdomen
Physical Examination
Observational Studies
Retrospective Studies
Prospective Studies
Population

Keywords

  • Blunt trauma
  • Pelvic fracture
  • Pelvic radiograph
  • Pelvic X-ray

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Implementation of a cost-saving algorithm for pelvic radiographs in blunt trauma patients. / Barleben, Andrew; Jafari, Fariba; Rose, John S; Dolich, Matthew; Malinoski, Darren; Lekawa, Michael; Hoyt, David; Cinat, Marianne.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 3, 09.2011, p. 582-584.

Research output: Contribution to journalArticle

Barleben, Andrew ; Jafari, Fariba ; Rose, John S ; Dolich, Matthew ; Malinoski, Darren ; Lekawa, Michael ; Hoyt, David ; Cinat, Marianne. / Implementation of a cost-saving algorithm for pelvic radiographs in blunt trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 3. pp. 582-584.
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abstract = "BACKGROUND:: In a previous retrospective study, we demonstrated that pelvic radiographs (PXRs) in the evaluation of blunt trauma patients undergoing abdominal computed tomographic (CT) scanning have limited utility in the absence of hemodynamic instability and significant physical findings. The purpose of this study was to prospectively validate an algorithm defining indications for PXR in blunt trauma patients in the emergency department. METHODS:: We performed a prospective observational study of consecutive blunt trauma patients over 6 months at a single Level 1 trauma center. The trauma faculty agreed to implement an algorithm of obtaining PXRs in patients undergoing abdominal CT scanning only if a specific set of criteria were met: systolic blood pressure <90 mm Hg, hemoglobin <8 mg/dL, a drop in Hgb of more than 3 mg/dL while in the trauma bay, or significant physical examination findings. The algorithm could be overridden at the discretion of the attending physician. RESULTS:: Nine hundred ninety-five consecutive blunt trauma patients whose evaluation was to include an abdominal CT scan were included in the study. Only 54 patients (6{\%}) received a PXR. Fifty-six indications for PXR were provided: 35 (63{\%}) severe pelvic pain, 14 (25{\%}) proximal fractures, 3 (5{\%}) hip dislocations, and only 4 (7{\%}) had unexplained hypotension. No adverse events or delays in care occurred such as hypotension in the CT scanner or a delay in contacting interventional radiology, blood transfusion, or application of a pelvic binder. The algorithm selected PXR for patients who were more likely to have a pelvic fracture (33{\%} vs. 4.5{\%}, p < 0.001), hip dislocation (7.4{\%} vs. 0.1{\%}, p < 0.001), femur fracture (22.2{\%} vs. 2.7{\%}, p < 0.001), and to require blood transfusion (11.1{\%} vs. 1.9{\%}, p < 0.001). Implementation of this algorithm resulted in a decrease in charges of >$226, 000 in 6 months. CONCLUSION:: When objective evaluation of the abdomen is to be obtained via CT scanning, PXR in the emergency department is obsolete in the absence of hemodynamic instability and significant physical examination findings. Implementation of a selective algorithm in this patient population can result in significant cost savings without adverse patient outcomes.",
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AU - Hoyt, David

AU - Cinat, Marianne

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N2 - BACKGROUND:: In a previous retrospective study, we demonstrated that pelvic radiographs (PXRs) in the evaluation of blunt trauma patients undergoing abdominal computed tomographic (CT) scanning have limited utility in the absence of hemodynamic instability and significant physical findings. The purpose of this study was to prospectively validate an algorithm defining indications for PXR in blunt trauma patients in the emergency department. METHODS:: We performed a prospective observational study of consecutive blunt trauma patients over 6 months at a single Level 1 trauma center. The trauma faculty agreed to implement an algorithm of obtaining PXRs in patients undergoing abdominal CT scanning only if a specific set of criteria were met: systolic blood pressure <90 mm Hg, hemoglobin <8 mg/dL, a drop in Hgb of more than 3 mg/dL while in the trauma bay, or significant physical examination findings. The algorithm could be overridden at the discretion of the attending physician. RESULTS:: Nine hundred ninety-five consecutive blunt trauma patients whose evaluation was to include an abdominal CT scan were included in the study. Only 54 patients (6%) received a PXR. Fifty-six indications for PXR were provided: 35 (63%) severe pelvic pain, 14 (25%) proximal fractures, 3 (5%) hip dislocations, and only 4 (7%) had unexplained hypotension. No adverse events or delays in care occurred such as hypotension in the CT scanner or a delay in contacting interventional radiology, blood transfusion, or application of a pelvic binder. The algorithm selected PXR for patients who were more likely to have a pelvic fracture (33% vs. 4.5%, p < 0.001), hip dislocation (7.4% vs. 0.1%, p < 0.001), femur fracture (22.2% vs. 2.7%, p < 0.001), and to require blood transfusion (11.1% vs. 1.9%, p < 0.001). Implementation of this algorithm resulted in a decrease in charges of >$226, 000 in 6 months. CONCLUSION:: When objective evaluation of the abdomen is to be obtained via CT scanning, PXR in the emergency department is obsolete in the absence of hemodynamic instability and significant physical examination findings. Implementation of a selective algorithm in this patient population can result in significant cost savings without adverse patient outcomes.

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