Condition And Associated Factors Of Ionizing Radiation In Major Trauma Patients:a Prospective Comparative Study

BACKGROUND:Repeated computed tomography (CT) scans and plain radiography result in high radiation dose exposure to major trauma patients, which has been clearly linked to the development of cancer. The purpose of our study was to explore composition, temporal distribution and associated factors in the radiological examination of major trauma patients, to provide a scientific basis for an optimized radiological examination strategy.METHODS:A prospective comparative study was carried out from April2011to November2011in a Chinese tertiary hospital. Clinical data from160major trauma patients admitted to an emergency intensive care unit (ICU) were evaluated. The type, number, site composition, temporal distribution and radiation dose of radiological examination were described and compared among different stages of treatment. The correlation among number, radiation dose of radiological examinations and age, number of injured sites, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU and overall hospital length of stay (LOS) was analyzed, respectively. The numbers of radiological examinations before and after taking restrictive measures were also compared.RESULTS:(1) The majority of examinations involved radiography and CT, with a median of6.0(3.0-11.0, Interquartile Range [IQR]) and10.0(8.0-13.8, IQR) per patient, respectively. The composition of sites imaged using radiography and CT were significantly different at different stages of treatment (χ2=114.609and75.932, respectively; both P<0.001).(2) The number of CT scans was positively correlated with the number of injured sites, ISS, ICU LOS (r=0.369and0.523, respectively; both P<0.05).(3) After the restrictive measures were taken, both of the numbers of CT scans and total radiological examinations of trauma patients were decreased from the previous level(CT:8times VS10times, Z=-2.410, p=0.016; Total radiological examinations:13.6times VS17.8times, Z=-3.044, p=0.002).(4)97.2percentage of radiation dose come from CT scans, While the radiography was2.8percentage. On the average,36.3(22.3-59.3, IQR) mSv radiation dose exposured to major trauma patients. The majority of radiation dose irradiated abdomen and thoracic region, with a proportion of41.8%and28.7%, respectively. On the first day after hurted, trauma patients received33%radiation dose. The trauma patients exposed more radiation dose when they were in ICU than when they were in the general ward (χ2=6.587,p=0.010). The composition of sites exposured to ionizing radiation were significantly different at different stages of treatment (χ2=370.24, P<0.001). The radiation dose was correlated with craniocerebral trauma, abdominal trauma, ICU LOS and the number of radiological examinations (r=-0.297,0.443,0.520and0.537, respectively; all P<0.05).(6) The CT indexes (CTDIV, scan layer and DLP) among different scans on the same site of the same patient were significantly different.19.9%head CT scans and7.2%cervical vertebra CT scans did not success at the first attempt, the additional scans made the radiation dose irradiated head and neck increased17.5%and7.2%, respectively.(7) Further reductions in the CT scans of head and chest could be achieved. And then the number of total radiological examinations, total radiation dose and the fee of radiological examination will been significantly decreased, with a proportion of7.2%,5.4%and8.1%, respectively.CONCLUSIONS:The total number of radiological examinations which result in high radiation dose undergone by major trauma patients in our study was high, and mainly comprised radiography and CT. The radiation dose was correlated with with craniocerebral trauma, abdominal trauma, ICU LOS and the number of radiological examinations. Increase clinician’s awareness of radiation damage and optimize radiology application system are helpful to reduce the number of radiological examinations. Reduce the repeat CT scans of the same site, using low-dose scanning program and increase the one-time scanning success rate can cut down on the radiation dose of major trauma patients.