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POLYTRAUMA CT AT LTHT�2018 AUDIT

Dr T Aderotimi (ST4)

Dr H Boryslawskyj (ST2)

Dr A Gangahar (ST2)

Dr P Whittaker (ST2)

Dr C Tingerides (Consultant Vascular Radiologist)

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BACKGROUND

  • LTHT became a designated major trauma centre in 2013

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  • “A change in the organisation of care for patients with severe injuries, including the development of Major Trauma Networks was associated with a significant 19% increase in the odds of survival for trauma victims who reach the hospital alive”

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STANDARDS (1)

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  • Based on RCR “Standard of practice and guidance for trauma radiology in severely injured patients. Second edition”
  • Aim for 100% compliance

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1. Time from referral to CT should be <30 minutes

2. Time from CT to verified report on PACS should be <60 minutes

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PREVIOUS RESULTS – AUDIT 2015

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1. Time from referral to CT should be <30 minutes

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2. Time from CT to verified report on PACS should be <60 minutes

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METHODS (1)

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  • Inclusion criteria: Patients >16years, undergoing whole body trauma CT or CT T/A/P only .
  • Exclusion criteria: Patients <16years , undergoing CT Head +/-cervical spine only

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  • Data Collection
    • Retrospective data collection using CRIS/PACS/TARN data.
    • 1 month data collection to cover all trauma patients who meet the inclusion criteria (Feb 2018)

 

  • Time from referral to CT should be <30 minutes

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  • Time from CT to verified report on PACS should be <60 minutes

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RESULTS - 2018

  • Total N= 99

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  • Request type

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REFERRAL TO SCAN TIME

No referral time

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Average time from request to scan

00:25:52

Median time from request to scan

00:19:00

Less than 15 mins

N=34

15 mins-30 mins

N=32

31-60 mins

N=4

More than 60 mins

N=11

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REFERRAL TO SCAN TIME – DELAYED CASES

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SCAN TO VERIFIED REPORT TIME

Average time to report: 49mins

Average time to report: 100mins

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SCAN TO VERIFIED REPORT TIME

2018

    • Time from CT to verified report on PACS should be <60 minutes
    • Target 100%

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  • Overall 66 %
  • In Hours 33.3 %
  • On call 74.1 %

2015

    • Time from CT to verified report on PACS should be <60 minutes
    • Target 100%

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  • Overall 35%
  • In Hours 25%
  • On call 39%

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DISCREPANCY RATE BETWEEN REGISTRAR AND CONSULTANT REPORTS (2)�

  • Audit standards (based on RCR national audit of emergency abdominal CT)
  • Review of on on-call trauma CT reports to compare discrepancy rate

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    • Major: a change or potential change in management or diagnosis. Target <10%

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    • Minor: would not result in any significant changes. Target <20%

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METHODS (2)

Inclusion criteria: Patients >16 years, undergoing whole body trauma CT (including T/A/P only)

  • Examinations performed on-call (5pm-9am mon-fri, and all day weekends)

Exclusion criteria: Patients <16 years, undergoing CT Head +/-cervical spine only

  • Examinations performed within normal working hours.

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Data Collection

  • Retrospective data collection using CRIS/PACS/TARN data.
  • 1 month data collection (Feb 2018)
  • Comparison made between on call report and consultant verified report.
  • Reports rated as no discrepancy, major discrepancy, minor discrepancy
  • Additional 3 month retrospective data collection using parameters as above for ISS >16 patients i.e. severely injured.

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DISCREPANCIES WITH ON CALL REPORT

  • Total cases scanned N=99.
  • Total cases scanned OOH N=81
  • Discrepancies on call N=17 (21%)
    • Trauma N = 14 (82%)
      • Major N = 3
      • Minor N = 11
    • Incidental N = 3 (18%)
      • Major N = 0
      • Minor N = 3

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RCR RECOMMENDATION

2018

    • Major: a change or potential change in management or diagnosis. <10%

N = 3/ 81= 3.7%

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    • Minor: would not result in any significant changes <20%

N = 14/81 = 17.3 %

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2015

    • Major: a change or potential change in management or diagnosis. <10%

N =

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    • Minor: would not result in any significant changes <20%

N =

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SEVERELY INJURED PATIENT

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SEVERELY INJURED PATIENT

  • Additional 3 month retrospective data collection using parameters as above for ISS >16 patients i.e. severely injured.

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DISCUSSION

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RECOMMENDATIONS

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QUESTIONS

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EDUCATIONAL CASES FROM 2018 TRAUMA AUDIT .

Dr T Aderotimi (ST4)

Dr H Boryslawskyj (ST2)

Dr A Gangahar (ST2)

Dr P Whitaker (ST2)

Dr C Tingerides (Consultant Vascular Radiologist)

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CASE 1. RTA VS PEDESTRIAN

  • Worrying features
    • Hand on abdomen
    • No pelvic binder

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CASE 1. RTA VS PEDESTRIAN

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CASE 1. RTA VS PEDESTRIAN

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CYSTOGRAM

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CASE 1 – EDUCATIONAL POINT

  • Pelvic fractures
  • Extra peritoneal fluid
    • High suspicion for bladder injury
  • Guideline LTHT.

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CASE 2

  • 4305250

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CASE 2 – EDUCATIONAL POINT

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CASE 3 RTA

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CASE 3 RTA

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CASE 3 – EDUCATIONAL POINT

  • Bilateral occipital condyle avulsion fractures secondary to apical ligament avulsion
  • Unstable injury

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QUESTIONS