It’s Time to Ditch the Disk: On Trauma

 

Mathieu _JeannetteJeannette Mathieu, MD, University of California at San Francisco, and Israel Saramago, MD, University of North Carolina at Chapel Hill, contributed this post.

Opinions are the authors’ own and do not reflect their institutions’ opinions.

Time is critical when caring for trauma patients. Injuries with high morbidity and mortality, such as intra-abdominal hemorrhage, spinal cord compression or pneumothorax, often develop and progress rapidly. Emergency and trauma physicians rely on radiologists to quickly identify these injuries in order to guide lifesaving treatment decisions. Instantaneous digital image sharing can dramatically improve timeliness of patient care, particularly in the trauma setting.

Critically injured patients frequently undergo initial workup at smaller, local hospitals before transferring to Level 1 trauma centers for specialized treatments, such as emergency neurosurgery to decompress a brain bleed, vascular surgery to repair a ruptured aorta or interventional radiology to embolize an uncontrollable pelvic hemorrhage.Saramago_Israel

Relying on CDs to share images can cause delays in care, as the disk must be physically sent to the new hospital and uploaded to PACS before a radiologist can review it. Sometimes, patients are re-scanned at the new hospital due to their CDs being unavailable or corrupted. Digital image sharing allows referring hospitals to immediately send images to trauma centers so that radiologists can expedite treatment planning by evaluating an unstable patient’s imaging while the patient is en route.

In addition to facilitating transfers, digital image sharing provides rapid access to a given patient’s prior studies regardless of where they were performed. This can help radiologists discern which findings are chronic versus acute. For instance, radiologists commonly recommend additional CT angiogram and MRI to evaluate the vasculature and ligaments, respectively, in patients presenting with acute cervical spine fractures. However, old fractures can sometimes mimic acute fractures. When the chronicity of a fracture is equivocal, prior images can determine which are old and warrant no further work-up.

Creating and sending CDs between facilities is an unnecessarily slow and unreliable method of sharing time-sensitive data. Duplicating imaging studies patients have already received elsewhere or inadvertently ordering additional unneeded studies because prior images aren’t available to establish the chronicity of a finding is wasteful and can cause unnecessary radiation exposure. These practices can be greatly reduced by switching to digital image sharing.

Join us on our journey to #DitchTheDisk and improve the standard of care for trauma patients. The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark attempt to improve the method of imaging transfer. To get involved, please fill out this form or email ditchthedisk@acr.org.

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