Redundant Computed Tomography in Maxillofacial Trauma: A National Analysis of Frequency and Predictors Following Interfacility Transfer.

BACKGROUND

Duplication of computed tomography (CT) imaging following interfacility transfer for trauma is a well-established systems level inefficiency. However, the incidence and drivers of repeat imaging have not been examined within the maxillofacial trauma demographic.

PURPOSE: The purpose was to estimate the frequency and factors associated with redundant maxillofacial CT imaging among adults transferred for isolated facial fractures.

STUDY DESIGN, SETTING SAMPLE: This was a retrospective cohort study using the American College of Surgeons National Trauma Data Bank from 2017 to 2024. Patients at least 18 years of age, transferred for management of isolated facial fractures, were included. Patients with missing data were excluded.

PREDICTOR VARIABLE: The predictor variable was a set of factors categorized as demographic (age, sex), clinical (Charlson comorbidity index), injury-related (fracture location), and hospital-level characteristics (bed size, teaching status).

MAIN OUTCOME VARIABLE: The primary outcome was duplicated imaging, defined as the receipt of a dedicated maxillofacial CT scan at the receiving trauma center within 24 hours of arrival.

COVARIATES: None.

ANALYSES: Descriptive, bivariate, and multivariable logistic regression statistics were computed to measure the associations between study variables and duplicated imaging. An alpha threshold of P < .001 was considered statistically significant.

RESULTS

The cohort consisted of 72,766 subjects with a mean age of 47.0 ± 20.2 years and was 69.8% male (n = 50,817). Redundant imaging occurred in 16.8% (n = 12,206) of the cohort over the study period. In the fully adjusted model, the strongest predictor of redundancy was the receipt of a trauma pan-scan (odds ratio [OR] = 11.0, 95% CI 10.2 to 11.9, P < .001). Other predictors included for-profit status (OR = 1.65, 95% CI, 1.55 to 1.76), university hospitals (OR = 1.27, 95% CI, 1.16 to 1.40), and mandibular fractures (OR = 1.28, 95% CI, 1.19 to 1.37) (all P < .001). Conversely, hospitals with >600 beds were less likely to duplicate scans (OR = 0.59, 95% CI, 0.52 to 0.67, P < .001). Repeated imaging was associated with a 2 to 3% increase in operative intervention for fractures of the mandible, maxilla, and orbit (all P < .001).

CONCLUSIONS AND RELEVANCE: Imaging redundancy affects approximately one in 6 transferred facial trauma patients and is driven primarily by trauma imaging protocols and hospital characteristics.