E. Herfel1, E. Buggie2, M. Lieber2, J. Hill2 1OhioHealth Doctors Hospital,Obstetrics And Gynecology,Columbus, OH, USA 2OhioHealth Grant Medical Center,Trauma Services,Columbus, OHIO, USA
Introduction: Trauma is the leading cause of non-obstetrical causes of death in pregnant patients. The use of radiographic imaging for evaluation of a pregnant trauma patient in the trauma bay is controversial, considering research has linked radiation exposure to inappropriate development in some children. However, in critical cases the benefits of using radiographic imaging to ensure maternal survival outweigh the risks of radiation exposure to the fetus. This study explored whether sparing fetal exposure to radiation by minimizing use of radiographic imaging put the mother at risk for a delayed diagnosis of injury. We hypothesize that minimizing the use of radiographic imaging in the initial assessment of pregnant trauma patients will not lead to a higher incidence of a delayed diagnosis or missed injury.
Methods: We performed a seven year retrospective chart review at an urban level 1 trauma center reviewing pregnant patients and a 2:1 cohort of non pregnant patients matched for age, injury severity score (ISS) and injury type, all involved in blunt trauma. Collected data points include: number and type of imaging studies performed on initial presentation and those images that were delayed. Delayed imaging was defined as any imaging study obtained two hours or more after arrival in the trauma bay. A delayed diagnosis was defined as any injury identified by delayed imaging. The primary outcome was incidence of delayed diagnosis in the pregnant trauma patient compared to the non-pregnant patient.
Results: A total of 83 pregnant patients and 167 non-pregnant patients were examined. Average age was 23.7 years and average ISS was 2.7 in both groups. 95.2% of the pregnant population had at least one imaging study done versus 100% of the control group (p=0.004). The pregnant population had an average of 4.3 images performed compared with an average of 6.8 images in the non pregnant cohort (p=<0.001). 18 (21.7 %) pregnant patients had delayed imaging and 58 (34.7%) control patients had delayed imaging (p=0.03). Only 1/18 of pregnant patients had a delayed diagnosis of a traumatic injury (transverse process fracture of the lumbar spine). 9/58 control patients had a delayed injury (p=0.17).
Conclusion: Our study demonstrates that bluntly injured pregnant trauma patients receive significantly fewer radiographic images upon presentation than their non-pregnant counterparts. However, only 1% of those pregnant patients had a delayed injury diagnosed. This was not significantly different from non-pregnant patients when matched for age and ISS. Though the ISS was low for both patient cohorts, this study suggests that mitigated radiographic imaging in the pregnant trauma patient is safe and does not result in delayed diagnosis of injury.