Computed tomography vs clinical and multidisciplinary procedures for early evaluation of severe abdomen and chest trauma - A cost analysis approach

Abstract

Objective

To compare contrast computed tomography (CT) for evaluating abdominal and vascular chest injuries after emergency room resuscitation with multidisciplinary management based on bedside procedure (BP), e.g., peritoneal lavage, abdomen ultrasonography urography and, if indicated, CT and/or aortography or transesophageal echocardiography. Design

Randomized study.Setting: Emergency, critical care and radiology departments in a trauma center. Patients

The study was performed in 103 severe blunt trauma patients with a revised trauma index<8, admitted over a 16 month period and divided into group 1 (G 1,n=52, CT management) and group 2 (G 2,n=51, BP management). Interventions

A relative direct cost scale used in our trauma center was applied, and cost units (U) were assigned to each diagnostic test for cost-minimization analysis (abdomen ultrasonograph=7.5 U, peritoneal lavage=8 U, urography=9 U, computed tomography=9 U, transesophageal echocardiography=13.5 U, and aortography=15 U). One unit is approximately equivalent to $ 43.7. Results

Injury severity score (ISS) was 31.7±15.4 in G1 and 33.8±18.3 in G2. Sensitivity for CT was 90.4% (G1) vs 72.5% for BP (G2) in abdomen (P<0.01) and 60% in chest for evaluating mediastinal hematoma etiology (G1). As Table 2 shows, G1 needed 59 tests for evaluating injuries (1.1±0.3 tests patient) while G2 required 81 tests (1.68±0.8 tests/patient) (P<0.01). The total relative cost was 538 U for G1, 7.04±2.2 U cost/injury and 10.3±3.3 U/evaluation of trauma vs 698 U for G2, 9.84±5.03 U cost/injury and 13.68±8.5 U/evaluation (P<0.05). Conclusions

This cost-minimization study suggests that CT is a more cost-effective method for the post-emergency room resuscitation evaluation of severe abdominal blunt trauma than the multidisciplinary BP. Chest CT is a screening method for mediastinal hematoma but not for etiology.