Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial

Objective

To determine the cost-effectiveness of trauma room CT compared with CT performed at the radiology department.

Methods

In this randomised controlled trial, adult patients requiring evaluation in a level 1 trauma centre were included. In the intervention hospital the CT system was located within the trauma room and in the control hospital within the radiology department. Direct and indirect medical costs of the institutionalised stay and diagnostic and therapeutic procedures were calculated.

Results

A total of 1,124 patients were randomised with comparable demographic characteristics. Mean number of non-institutionalised days alive was 322.5 in the intervention group (95?% CI 314?C331) and 320.7 in the control group (95?% CI 312.1?C329.2). Mean costs of diagnostic and therapeutic procedures per hospital inpatient day were ?554 for the intervention group and ?468 for the control group. Total mean costs in the intervention group were ?16,002 (95?% CI 13,075?C18,929) and ?16,635 (95?% CI 13,528?C19,743) for the control group (P?=?0.77).

Conclusion

The present study showed that in trauma patients the setting with a CT system located in the trauma room did not provide any advantages or disadvantages from a health economics perspective over a CT system located in the radiology department.

Key Points

? Computed tomography has become increasingly important in patients who have suffered trauma. ? Emergency departments either use embedded CT facilities or CT machines in the radiology department. ? The cost-effectiveness of CT was not influenced by the location of CT. ? The number of non-institutionalised days alive was not influenced by the location. ? Further assessment of optimal location of CT units is required.