1. Time to scan - factors that affect time to CT scan in major trauma
W. English1, A. West1, N. Durge2
1Department of Surgery, Royal London Hospital, London UK
2Emergency Department, Royal London Hospital, London UK
Background
The Royal London Hospital is London’s busiest major trauma centre and is home to London's Air Ambulance.
Trauma is a major cause of death and CT scanning is an invaluable tool in detecting major injuries in the severely injured patient. Guidelines suggest that CT scans should be performed within 60 minutes of arrival and ideally within 30 minutes.
Within the department there are two CT scanners. These are used by the A&E team, medical and surgical teams. The hospital is also a hyperacute stroke unit. There is a separate inpatient CT department.
Results
Over 12 months 3814 trauma calls went to CT (total = 5424).
2559 (67%) were consultant led (CL) (8%) were non consultant led (non-CL). The remaining 905 (25%) did not have a recorded team leader. CL trauma took a mean time of 54 mins and a median time of 43 mins to get to CT. Non-CL trauma took a mean time of 75 mins and a median time of 50 mins.
There were 134 pre-hospitalactivated code reds (mean 61 mins, median 31 mins) and 50 ED activated code reds (mean 59 mins, median 39 mins).
The majority of the CT scanned trauma was blunt force (n=2998). Penetrating trauma was second most common (n=802), then burns (n=9) and finally immersion (n=2).
Aims
As part of an annual audit of time to CT in major trauma we examined whether type of trauma (blunt/penetrating), seniority of team leader (consultant/non-consultant) or code red activation affected the time to CT scan.
Methods
We reviewed all major trauma patients that attended the Royal London Hospital between September 2014 and September 2015 using the trauma database that the hospital employs - electronic health record and PACS imaging.
All
trauma
Consultant
led
Non consultant led
number
3814
2559
305
mean time to ct
00:59
00:54
01:15
median time to ct
00:43
00:43:00
00:50:00 ★ ★ ★ ★
Discussion:
There is a statistically significant difference (p=<0.05) in time to CT between trauma calls that are led by a consultant and those led by a registrar. However the median time for both consultant and non consultant led cases is less than one hour.
The longer time delay in non consultant led cases can be explained by the fact that often registrar led traumas are less severe and therefore other cases within the department “jump the queue” ahead of them – such as a stroke call.
Equally when a trauma call is being led by a non-consultant this is likely due to the department being busy with other trauma. In the case of multiple trauma the consultant in charge will be team leading in the most critically unwell patient. This patient is likely going to need CT scanning first. Hence a delay for non consultant led trauma is inevitable.
There is still room for improvement in “time to CT” and the next aim should be a median time of 30 minutes. There needs to be consutlant support for all trauma to minimise delay to CT.