- Effective Radiologic Doses and Lifetime Attributable Risks in Patients with Trauma Critical Pathway Activation
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Wonhyo Lee, Taeyoung Kong, Seunghwan Kim, Je Sung You, Yoo Seok Park, Jae Gil Lee, Sung Phil Chung
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J Trauma Inj. 2013;26(3):198-206.
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 Abstract
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- PURPOSE
This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose.
METHODS
Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report.
RESULTS
A total of 76 patients were enrolled. The mean age was 49.0+/-8.5 years. The mean injury severity score (ISS) was 12.7+/-8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6+/-39.9 mSv. The CED in patients with an ISS> or =16(63.2+/-26.6 mSv) was higher than that of patients whose ISS<16(33.5+/-23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0+/-45.2 mSv) was higher than that of patients who were treated conservatively(33.6+/-22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5+/-308.6 and 189.0+/-159.3 per 100,000 people, respectively.
CONCLUSION
The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.
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Summary
- NEXUS and the Canadian Cervical Spine Rule as a Screening Tool for Computed Tomography Evaluation in Patients with Cervical Spine Injury
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Yang Hwan Choi, Junho Cho, Minhong Choa, Yoo Seok Park, Hyun Soo Chung, Sung Pil Chung
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J Korean Soc Traumatol. 2008;21(1):15-21.
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Abstract
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- PURPOSE
National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED).
METHODS
This prospective observational study was conducted from January 2007 to March 2008. Plain Xray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury.
RESULTS
During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied.
CONCLUSION
This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.
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Summary
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