Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients

Torrey A. Laack, Kathryn M. Thompson, James M. Kofler, Fernanda Bellolio, Mark D Sawyer, Nadia N Laack

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29 Citations (Scopus)

Abstract

BACKGROUND: Computed tomography (CT) is the primary source of nontherapeutic medical radiation exposure. Radiation exposure is associated with an increased risk of cancer mortality. Although the risk of cancer mortality is negligible in comparison with that of trauma mortality in high-risk patients, the balance of risk versus benefit in patients with less severe mechanisms of injury is unknown. METHODS: This observational cohort study using a trauma center registry included blunt trauma patients prospectively triaged to an intermediate risk group (level II). Radiation dose was calculated using average dosage for each CT scan. Age-adjusted attributable radiation risk for cancer mortality was calculated using Biological Effects of Ionizing Radiation VII data. RESULTS: Six hundred forty-two level II trauma patients were analyzed, with a mean age of 43.8 years and a median Injury Severity Score of 8. Patients received a median radiation effective dose of 24.7 mSv in the first 24 hours of medical evaluation. Higher Injury Severity Score was associated with greater total radiation dose. Of the four deaths, all were 80 years or older with intracranial injuries. The estimated risk of cancer death attributable to CT exposure was 0.1%. CONCLUSIONS: The risk of mortality from trauma is six times higher than the estimated risk of radiation-induced cancer mortality in intermediate level trauma patients. The mortality due to trauma is greatest in older patients, suggesting lower clinical suspicion is needed to warrant CT studies in this population. Efforts to reduce radiation exposure to trauma patients should focus on young patients with minor injuries.

Original languageEnglish (US)
Pages (from-to)1362-1365
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number6
DOIs
StatePublished - Jun 2011

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Tomography
Mortality
Wounds and Injuries
Neoplasms
Radiation
Injury Severity Score
Radiation-Induced Neoplasms
Trauma Centers
Ionizing Radiation
Observational Studies
Registries
Cohort Studies
Population
Radiation Exposure

Keywords

  • Cancer
  • Computed tomography
  • CT
  • Radiation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

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title = "Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients",
abstract = "BACKGROUND: Computed tomography (CT) is the primary source of nontherapeutic medical radiation exposure. Radiation exposure is associated with an increased risk of cancer mortality. Although the risk of cancer mortality is negligible in comparison with that of trauma mortality in high-risk patients, the balance of risk versus benefit in patients with less severe mechanisms of injury is unknown. METHODS: This observational cohort study using a trauma center registry included blunt trauma patients prospectively triaged to an intermediate risk group (level II). Radiation dose was calculated using average dosage for each CT scan. Age-adjusted attributable radiation risk for cancer mortality was calculated using Biological Effects of Ionizing Radiation VII data. RESULTS: Six hundred forty-two level II trauma patients were analyzed, with a mean age of 43.8 years and a median Injury Severity Score of 8. Patients received a median radiation effective dose of 24.7 mSv in the first 24 hours of medical evaluation. Higher Injury Severity Score was associated with greater total radiation dose. Of the four deaths, all were 80 years or older with intracranial injuries. The estimated risk of cancer death attributable to CT exposure was 0.1{\%}. CONCLUSIONS: The risk of mortality from trauma is six times higher than the estimated risk of radiation-induced cancer mortality in intermediate level trauma patients. The mortality due to trauma is greatest in older patients, suggesting lower clinical suspicion is needed to warrant CT studies in this population. Efforts to reduce radiation exposure to trauma patients should focus on young patients with minor injuries.",
keywords = "Cancer, Computed tomography, CT, Radiation",
author = "Laack, {Torrey A.} and Thompson, {Kathryn M.} and Kofler, {James M.} and Fernanda Bellolio and Sawyer, {Mark D} and Laack, {Nadia N}",
year = "2011",
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T1 - Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients

AU - Laack, Torrey A.

AU - Thompson, Kathryn M.

AU - Kofler, James M.

AU - Bellolio, Fernanda

AU - Sawyer, Mark D

AU - Laack, Nadia N

PY - 2011/6

Y1 - 2011/6

N2 - BACKGROUND: Computed tomography (CT) is the primary source of nontherapeutic medical radiation exposure. Radiation exposure is associated with an increased risk of cancer mortality. Although the risk of cancer mortality is negligible in comparison with that of trauma mortality in high-risk patients, the balance of risk versus benefit in patients with less severe mechanisms of injury is unknown. METHODS: This observational cohort study using a trauma center registry included blunt trauma patients prospectively triaged to an intermediate risk group (level II). Radiation dose was calculated using average dosage for each CT scan. Age-adjusted attributable radiation risk for cancer mortality was calculated using Biological Effects of Ionizing Radiation VII data. RESULTS: Six hundred forty-two level II trauma patients were analyzed, with a mean age of 43.8 years and a median Injury Severity Score of 8. Patients received a median radiation effective dose of 24.7 mSv in the first 24 hours of medical evaluation. Higher Injury Severity Score was associated with greater total radiation dose. Of the four deaths, all were 80 years or older with intracranial injuries. The estimated risk of cancer death attributable to CT exposure was 0.1%. CONCLUSIONS: The risk of mortality from trauma is six times higher than the estimated risk of radiation-induced cancer mortality in intermediate level trauma patients. The mortality due to trauma is greatest in older patients, suggesting lower clinical suspicion is needed to warrant CT studies in this population. Efforts to reduce radiation exposure to trauma patients should focus on young patients with minor injuries.

AB - BACKGROUND: Computed tomography (CT) is the primary source of nontherapeutic medical radiation exposure. Radiation exposure is associated with an increased risk of cancer mortality. Although the risk of cancer mortality is negligible in comparison with that of trauma mortality in high-risk patients, the balance of risk versus benefit in patients with less severe mechanisms of injury is unknown. METHODS: This observational cohort study using a trauma center registry included blunt trauma patients prospectively triaged to an intermediate risk group (level II). Radiation dose was calculated using average dosage for each CT scan. Age-adjusted attributable radiation risk for cancer mortality was calculated using Biological Effects of Ionizing Radiation VII data. RESULTS: Six hundred forty-two level II trauma patients were analyzed, with a mean age of 43.8 years and a median Injury Severity Score of 8. Patients received a median radiation effective dose of 24.7 mSv in the first 24 hours of medical evaluation. Higher Injury Severity Score was associated with greater total radiation dose. Of the four deaths, all were 80 years or older with intracranial injuries. The estimated risk of cancer death attributable to CT exposure was 0.1%. CONCLUSIONS: The risk of mortality from trauma is six times higher than the estimated risk of radiation-induced cancer mortality in intermediate level trauma patients. The mortality due to trauma is greatest in older patients, suggesting lower clinical suspicion is needed to warrant CT studies in this population. Efforts to reduce radiation exposure to trauma patients should focus on young patients with minor injuries.

KW - Cancer

KW - Computed tomography

KW - CT

KW - Radiation

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