Discussion

The majority of CT head and c-spine scans were considered indicated at our institution. Clear and consistent NICE guidance facilitate clinicians in deciding which patients require imaging.

In contrast, many of the body CTs (thorax/abdomen/pelvis) did not appear to be indicated. This is concerning considering that 39% of patients scanned are under the age of 65  potentially exposing this group to unnecessary radiation.

Most patients who fall into the SIPs category are transferred directly to a major trauma unit. CT appears to be overused as a first-line investigation in stable patients who attend A&E at our institution. Plain digital radiography is underutilised particularly in the initial assessment of the c-spine and thorax. This may be due to a combination of factors which includes pressures placed on A&E to establish a management plan rapidly, lack of staff experienced in trauma and no local imaging pathway guidelines for the assessment of this cohort of patients.

Limitations

1.  Patients who did not have a CT scan were not included.

2. Indications for CT  scans were taken from the request form. The information provided does not always  reflect the clinical status of the patient.

Recommendations

1. Identify factors which may cause a delay in scans being performed and reported.

2. Introduce local guidelines for trauma imaging in patients who do not fall into the severely injured category with the aim of reducing radiation exposure particularly in younger patients.