Plain radiological investigations in admissions to a trauma centre ICU

Introduction

As the tertiary centre in Northern Ireland, severely injured patients are transferred to Royal Victoria Hospital (RVH) regional ICU for further definitive management. Minimum radiology should be performed before transfer.

Methods

ICU transfers from the emergency department (ED), RVH and district general hospital (DGH), to the trauma centre were prospectively audited over 4 months.

Results

Thirteen patients were admitted from RVH ED, 25 from a DGH ED. Spinal injury was diagnosed in 7.7% in the RVH group versus 28% from the DGH ED. The median time to clear the cervical spine was 24 hours (RVH) versus 48 hours (DGH), and the thoracolumbars was 34 hours (RVH) versus 48 hours (DGH). See Tables 1 and 2.

Table 1 Plain radiological investigations performed

Table 2 Injuries identified prior to ICU admission

Conclusion

Despite Advanced Trauma Life Support guidelines, plain X-ray scans of the lateral cervical spine, chest and pelvis are not routinely performed in all trauma patients. Not all spinal injuries are being detected by radiology performed in EDs. Significant delays in clearance of spinal injuries occur despite a protocol in place, exposing patients to other potential risks. The development of a critical care network in Northern Ireland should allow the standardisation of pre-ICU management of trauma patients.