Abstract
Objective
Trauma is the leading cause of non-obstetrical causes of death in pregnant patients.
The use of radiographic imaging for evaluation in the trauma bay is a controversial
topic. However, in some cases the benefits of using radiographic imaging to ensure
maternal survival outweigh the risks of radiation exposure to the fetus. This study
explores whether sparing fetal exposure to radiation by minimizing use of ionizing
radiographic imaging to the mother will 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 does not lead to a higher incidence of delayed
diagnosis.
Study Design
A retrospective chart review at an urban level 1 trauma center reviewing pregnant
patients involved in blunt trauma and a cohort of non-pregnant patients matched for
age and ISS. Data points included: number and type of imaging studies performed on
initial presentation and the number and type of imaging studies that were delayed.
The primary outcome was incidence of delayed diagnosis in the pregnant trauma patient
compared to the non-pregnant patient.
Results
83 pregnant and 167 non-pregnant patients were examined. Average 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). This led to an incidence of delayed
diagnosis in 1% of pregnant patients and 5% control patients (p = 0.17).
Conclusion
Our study shows that bluntly injured pregnant trauma patients receive significantly
fewer radiographic images upon presentation than their non-pregnant counterparts.
However, this led to insignificant difference in delay of injury diagnosis between
pregnant and 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.
Keywords
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References
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Article info
Publication history
Published online: July 02, 2018
Accepted:
June 27,
2018
Received in revised form:
June 12,
2018
Received:
April 12,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
