Adequacy of clinical information on multidetector computed tomography (MDCT) requests for adult patients presenting following major trauma

An audit to assess the adequacy of clinical information on major trauma MDCT imaging requests from the Emergency Department (ED)

There is evidence to suggest correlation between inadequate clinical information and inaccurate radiology reports. 

The RCR document on ‘Major adult trauma radiology guidance, June 2024 edition’ outlines the standards expected in the care and management of adult patients following major trauma. Standard 7 in this guidance states that an MDCT request in the trauma setting should comply with the Ionising Radiation (Medical Exposure) Regulations 2020 justification requirements in the same way as any other request for imaging involving ionising radiation. 

The guidance suggests that an annual audit of MDCT requests in major trauma should be performed to ensure adherence to these regulations, with the results disseminated to the entire multidisciplinary team.

The standard: 

Standard 7 in the ‘Major adult trauma radiology guidance, June 2024 edition’ states that the minimum expected clinical information provided on a multidetector computed tomography (MDCT) request should include the following information:

• Mechanism of injury.
• Primary survey findings and areas of concern.
• Haemodynamic instability.
• Results of any preceding investigations (such as focused abdominal sonography in trauma [FAST] or digital radiography [DR]).
• Any significant medical or surgical history, if known.
• Accurate contact details of the trauma team leader (TTL) or other responsible senior staff member.

A request pro forma example has also been provided in the guidance (Appendix 2), which may be modified according to local requirements.

Target:

100% of radiology requests for trauma MDCT imaging should include the minimum expected clinical information outlined in the standard.

Indicators: 

Inclusion of relevant clinical information on MDCT requests as outlined in the standard.

Data items to be collected:

Clinical information on trauma CT requests from the relevant radiology information system (RIS).

Suggested number:

Retrospective collection of 100 (or 1 month worth of) trauma CT requests from the Emergency Department.

1. Present audit findings to the Emergency Department team and discuss the benefits of clinical information at the time of CT trauma imaging referrals. 
2. Present audit findings to the Radiology Department team and discuss an approach to rejecting unjustified radiology requests. 
3. Give immediate constructive feedback to the referrer after receiving unjustifiable radiology requests for polytrauma scans. 
4. Suggest introducing a trauma imaging request pro forma or using clinical decision support software incorporating essential clinical information for reference when filling in the clinical information during imaging requests. Protocol driven scan justification could be introduced if essential information given and in line with
5. Re-audit in 1 year.

1. https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/major-adult-trauma-radiology-guidance/
2. Neef, S., Meinel, F.G., Lorbeer, R. et al. Time trend analysis of Injury Severity score of adult trauma patients with emergent CT examination. Emerg Radiol 31, 507–514 (2024). https://doi.org/10.1007/s10140-024-02253-x

Dr Christopher Clarke

Co-authors: 

Dr Megan Ridgway, Dr Althaf Abdul Rasheed