Trauma team radiation exposure: the potential need for dosimetry monitoring.

OBJECTIVES: Australian radiation regulations require routine monitoring of health-care workers who might receive a whole-body effective radiation dose in excess of 1 mSv/year. In Australian hospitals, routine monitoring with a dosimeter is recommended for levels beyond 300 microSv/year. We aimed to determine the potential radiation exposure to trauma team members and whether routine personal radiation dosimetry should be recommended. METHOD: An anthropomorphic mannequin with a radiation detector was placed at five locations around the resuscitation bed. Three sets of standard trauma-series X-rays were performed, and the exposure was measured and averaged at each location. These data were then extrapolated to estimate the potential radiation equivalence at the level of the thyroid gland for staff working in each of the locations over a 1 year period with and without personal protective equipment. RESULTS: The total dose ranged from 1.2 to 20.5 microSv for a single trauma patient. The highest recorded dose was at the location of the circulation doctor during pelvic X-ray. Based on these data, it would take only 15 trauma patients per year for a team member to be potentially exposed to the level at which routine dosimetry is usually recommended, should no personal protective equipment be used. The use of a lead gown and a lead gown with a thyroid collar reduced exposure by four- and ninefold, respectively. CONCLUSIONS: We have demonstrated the possibility of significant ionizing radiation exposure for unprotected trauma team members. Dosimeter use by trauma team personnel needs to be reviewed based on local protocols and patient numbers.

Trauma bypass in south-eastern Sydney: an 8-year review.

OBJECTIVE: The New South Wales (NSW) Health Department and the Ambulance Service of NSW introduced a trauma bypass system in Sydney on 29 March 1992. This study aims to review the outcomes of trauma bypass patients brought to St George Hospital, a major trauma service in south-eastern Sydney, and to assess the performance of the current prehospital trauma triage protocol. METHODS: The St George Hospital Department of Trauma Services prospectively collected data on all trauma bypass patients for the 8-year period from 29 March 1992 to 29 March 2000. RESULTS: A total of 1990 patients were brought to hospital on trauma bypass. The average age was 32 years, 70% were men and 66% were from road traffic accidents. The positive predictive value of the prehospital triage tool for serious injury (Injury Severity Score [ISS] > 15) was 18.6% (95% CI 16.9-20.4). This is well below the benchmark previously established by the NSW Health Department Trauma System Advisory Committee. For all trauma bypass patients, 33.8% (95% CI 31.7-35.9) were discharged home from the ED. The overall death rate was 2.5% (95% CI 1.9-3.3). CONCLUSIONS: According to the proposed benchmark, current prehospital trauma triage guidelines are underperforming. This suggests that a review of the benchmarks of current local trauma systems and of the trauma triage tool is required.

Cranial CT interpretation by senior emergency department staff.

The aims of the present study were to determine the rate of misinterpretation of non-contrast cranial CT scans by emergency specialists and trainees compared with specialist radiologists, and the proportion of misinterpretations that is consequential. A 12-month prospective blinded cohort study was performed. One-hundred and ninety of 1,282 scans (14.8%) were misinterpreted, and 78 of these (41.1%) were of potential or actual consequence. We conclude that the performance of senior emergency department staff in non-contrast cranial CT interpretation is no better than moderately good, and a large proportion of misinterpretations are of potential or actual clinical consequence.