Effectiveness of CT Scans in Trauma Patient at the Emergency Room, Bangkok Hospital Pattaya, Chonburi Province

Abstract

OBJECTIVES: To study the safety of radiation doses, comparing radiation exposure between whole body and divided into sections of computed tomography (CT) scan performed. Assess the safety of the amount of radiopaque contrast received and the effect on kidney function, Creatinine Glomerular Filtration Rate (GFR), in each type of CT scan. The under-covered diagnosis among trauma patients who were not sent for CT Trauma Body examination from the first time at the emergency room in order to find the cost-effectiveness of CT scans.

MATERIALS AND METHODS: Retrospective descriptive research study to answer research questions and study trauma patients who received whole-body scan and divided into sections, such as CT Brain, CT Cervical Spine (C-Spine), CT Chest, CT Abdomen. Between 1 January 2018 - 30 September 2023 records sourced from the X-ray department Bangkok Hospital Pattaya (BHP), Chonburi Province. The number of trauma patients: 5,507 cases from 5,833 records.

RESULTS: 1) Safety of radiation dose received from whole body and segmental CT scans. It can be concluded that, 1) segmental CT scans receive less radiation than whole body CT scans. While the in-patient department (IPD) examination results of trauma patients who underwent whole body CT scans had radiation doses that trauma patients received equal to 124.53 milligray (mGy), and segmental examinations received less radiation than whole body examinations, namely, brain CT equal to 62 mGy, total abdominal CT equal to 20 mGy, chest CT equal to 18 mGy, and spine CT equal to 24.53 mGy. 2) Safety of radiation doses affects the GFR of kidney creatinine from each type of CT scan. It was found that most trauma patients who were referred for examination received 370 nanometers of ultraviolet radiation. 3) Safety from incomplete diagnosis in patients who did not receive the first CT Trauma Body examination in the emergency room. It was found that injured patients were at risk from incomplete diagnosis from the first examination in the emergency room. leading to a repeat referral from the IPD and 4) the cost-effectiveness in terms of the cost of sending a CT Trauma Body examination. It was found that injured patients who underwent a CT Trauma Body examination had an average total cost of 28,640.26 baht (842.36 United States dollar (USD)), while the cost of sending a separate examination averaged 51,727.63 baht (1,521.40 USD). When considering the cost- effectiveness of a CT scan, it was found that a whole-body examination was more worthwhile than a separate examination because these were expensive (when all the costs were added together).

CONCLUSION: Therefore, trauma patients who undergo a CT Trauma Body scan from the emergency room will benefit from comprehensive diagnostics, the absence of complications, rapid and complete recovery, and the avoidance of repeat scans. Additionally, the cost is lower compared to multiple, separate CT scans. However, the assessment for each type of radiological examination depends on the severity of the injury, the patient’s vital signs, level of consciousness, medical history, physical examination, physician’s judgment, and other precautions taken into consideration before ordering the scan.