Computed Tomography imaging of traumatic injuries at Chris Hani Baragwanath Academic Hospital

Dawadi, Shabina
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Background Computed Tomography (CT) imaging forms an important component in the evaluation and management of patients with traumatic injuries. Many South African emergency departments (EDs) have a significant trauma-related workload, especially in the public sector, where there are limitations in resources relating to CT scanners. It is important to gauge the impact of traumatic injuries on CT utilisation. Objectives The primary objectives were to quantify the amount and type of CT imaging studies trauma patients received, as well as to determine the amount of radiologically significant findings in a level 1 trauma centre. The secondary objectives were to determine the trauma unit’s CT utilisation rate and describe the demographics of patients who received imaging. Methods This was a retrospective, quantitative, descriptive, cross-sectional study undertaken over a two-month period at the radiology and trauma units of a tertiary, academic, teaching hospital in Johannesburg, South Africa. The radiology department’s Picture Archiving and Communication System (PACS) was used to evaluate the reports of patients who were referred for a CT scan from the level 1 trauma unit. The trauma unit register was used to calculate the CT utilisation rate. Results A total of 1277 CT scans were performed on 843 patients. CT brain accounted for 52% of all scans performed. Out of the 1277 CT scans, 407 scans (354 patients) demonstrated radiologically significant findings i.e. 31.9% of scans and 42% of patients. CT chest and peripheral angiogram demonstrated radiologically significant findings in 60.5% and 50.9% of scans respectively. Assault accounted for 55.8% of the injuries sustained and motor/pedestrian vehicle collisions 33.2%. The trauma unit’s CT utilisation rate was 16.7%. Conclusions South Africa suffers from a significant trauma-related injury burden mainly related to assault and motor vehicle/pedestrian collisions. This trauma pandemic has a great impact on the limited CT imaging services available. Worldwide there is a broad range of described CT utilisation rates and the findings of this study fall within that range, indicating acceptable usage of CT in this level 1 trauma centre. ED decision makers are encouraged to continue carefully using CT in the trauma setting.
A dissertation submitted in fulfilment of the requirements for the degree of Master of Medicine in Orthopaedic Surgery to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021