Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol

Objectives: To compare the proportion of patients exposed to a radiation dose in excess of 20 mSv, and to document missed injuries before and after the introduction of a panscan protocol for blunt trauma. Methods: Data were collected retrospectively from our trauma database for 6 months before and after implementation of the protocol. All radiological studies performed during the initial patient assessment were identified. Radiation doses for each patient were calculated. Subgroup analyses were age <= 30 and > 30 years, injury severity score (ISS) <16 and >= 16, and patient disposition as discharged from ED or admitted. Results: There were 656 patients before and 624 after the introduction of the protocol. The proportion of patients exposed to a radiation dose > 20 mSv increased by 8% (95% confidence interval [CI] 4-12), which equated to one extra person being exposed to > 20 mSv for every 13 patients treated after the introduction of the protocol. The odds of receiving a radiation dose > 20 mSv after the introduction of the protocol compared with the odds before were increased across all subgroups (<= 30 years: odds ratio [OR] 2.7, 95% CI 1.3-5.8, P = 0.008; > 30 years: OR 2.2, 95% CI 1.5-3.4, P < 0.001; ISS < 16: OR 2.4, 95% CI 1.5-3.9, P < 0.001; ISS >= 16: OR 2.0, 95% CI 1.0-3.7, P = 0.04; discharged home: OR 2.1, 95% CI 0.7-6.0, P = 0.17; admitted: OR 2.2, 95% CI 1.5-3.3, P < 0.001). There were six missed injuries before and four after. Conclusions: Introduction of a panscan protocol increased the proportion of trauma patients receiving a radiation dose > 20 mSv. This increased risk occurred regardless of age or injury severity.