1. Analysis of emergency radiology utilization after the Boston Marathon Bombing demonstrated increased redundant imaging orders and significant delays in time to radiograph completion.
2. Increased CT scanners availability and radiology staff prevented delays in CT image acquisition and interpretation.
Evidence Rating Level: 3 (Average)
Study Rundown: Over 260 people were injured in the Boston Marathon Bombings in 2013, resulting in a significant burden on the surrounding emergency radiology departments in the immediate aftermath. The authors of this study evaluated the effectiveness of the radiology protocol for massive casualty incidents (MCI) through retrospective analysis of key radiology workflow intervals for 40 patients who arrived at a local Level 1 trauma center. In the 24 hours after the incident, 149 imaging orders were placed; however, 76 (51%) orders were cancelled due to redundancy. Compared to the previous 12-month ER performance at the institution, there was a significant increase in the median time from image order to completion for radiographs (52 vs. 31 minutes, p<0.001), but not CT scans. Substantial increases in ER radiology staffing resulted in similar imaging interpretation turn-around-time for CT and radiographs compared to normal ER operations. These results re-enforce the importance of increasing availability of imaging equipment in MCI as the availability of a single radiography plate reader resulted in a substantial bottleneck. Furthermore, clear naming conventions for unidentified patients are needed to avoid duplicate and unnecessary imaging requests. Although these results are from a single center, they highlight the importance of MCI planning for individual hospitals.
In-Depth [retrospective cohort]: This retrospective review analyzed patient ER timeline data from Brigham & Woman’s Hospital (BWH) 24 hours after the Boston Marathon Bombings and compared to similar ER time intervals from the previous 12 months. In preparation for increased imaging demands, 3 additional CT scanners were dedicated exclusively for ER patients along with increases in ER radiology staffing. The results demonstrated that 40 patients arrived to the ER in the 24 hours after the attack, of which 31 (78%) underwent diagnostic imaging. Overall, 149 imaging orders were placed and only 73 imaging orders were completed (57 radiographs, 16 CT scans). A mean of 1.8 (range 1-7) providers ordered studies for patients that received imaging, resulting in increased number of cancelled orders and redundancy. Median image order to completion time was significant decreased for CT scans (37 vs. 72 min, p<0.01), but significantly increased for radiographs (52 vs. 31 min, p<0.001). No significant increases were detected in radiology turn-around time for both CT (75 vs. 74 minutes, p=0.55) and radiograph (71 vs. 49 minutes, p=0.22) interpretation.
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