Thoracoabdominal Computed Tomography in Trauma Patients: A Cost-Consequences Analysis

Background: CT is increasingly used during the initial evaluation of blunt trauma patients. In this era of increasing cost-awareness, the pros and cons of CT have to be assessed. Objectives: This study was performed to evaluate cost-consequences of different diagnostic algorithms that use thoracoabdominal CT in primary evaluation of adult patients with high-energy blunt trauma. Materials and Methods: We compared three different algorithms in which CT was applied as an immediate diagnostic tool (rush CT), a diagnostic tool after limited conventional work-up (routine CT), and a selective tool (selective CT). Probabilities of detecting and missing clinically relevant injuries were retrospectively derived. We collected data on radiation exposure and performed a micro-cost analysis on a reference case-based approach. Results: Both rush and routine CT detected all thoracoabdominal injuries in ۹۹.۱% of the patients during primary evaluation (n = ۱۰۴۰). Selective CT missed one or more diagnoses in ۱۱% of the patients in which a change of treatment was necessary in ۴.۸%. Rush CT algorithm costed € ۲۶۷۶ (US ۳۶۶۰) per patient with a mean radiation dose of ۲۶.۴۰ mSv per patient. Routine CT costed € ۲۸۱۵ (US ۳۸۵۰) and resulted in the same radiation exposure. Selective CT resulted in less radiation dose (۲۳.۲۳ mSv) and costed € ۲۷۷۱ (US ۳۷۹۰). Conclusions: Rush CT seems to result in the least costs and is comparable in terms of radiation dose exposure and diagnostic certainty with routine CT after a limited conventional work-up. However, selective CT results in less radiation dose exposure but a slightly higher cost and less certainty.

کلیدواژه ها:

Costs and Cost Analysis ، Wounds and Injuries ، Tomography ، X ، Ray Computed ، Thorax ، Abdomen