Ultralow-Dose CT (REDUCTION Protocol) for Extremity Fracture Evaluation Is as Safe and Effective as Conventional CT: An Evaluation of Quality Outcomes
Authors: Konda Sanjit R. , Goch Abraham M. , Haglin Jack , Egol Kenneth A. 
Published: February 2018

Objectives:
To assess clinical and hospital quality outcomes of patients receiving the previously reported Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury (REDUCTION) imaging protocol.

Design:
Retrospective Chart review.

Setting:
Level I Trauma Center and affiliated Tertiary Care Hospital Center.

Patients/Participants:
Fifty patients who received this protocol for acute traumatic fracture evaluation and met the inclusion criteria were compared with a cohort of 50 patients matched for age and fracture type who previously received conventional CT scanning for acute traumatic fracture evaluation.

Intervention:
Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury (REDUCTION) protocol for diagnostic fracture evaluation.

Main Outcome Measures:
Estimated effective radiation doses were calculated and compared using Digital Imaging and Communications in Medicine (DICOM) information from all included studies. Patient outcomes between groups were compared with time to fracture union as the primary outcome. Secondary outcome measures included the presence of complication defined as infection, malunion, nonunion, failure of nonoperative treatment, painful implants, and implant failure. Other secondary quality outcomes that were recorded included readmission within 30 days and hospital length of stay. Functional quality measures included joint range of motion. Statistical analyses were conducted to identify significant differences between cohorts (significance designated as P < 0.05).

Results:
Patient characteristics between cohorts were not significantly different with respect to age, sex, body mass index, comorbidities, injury mechanism, or injury location. Fractures of the elbow, hip, knee, and foot/ankle were evaluated. Mean clinical follow-up was 9.5 ± 4.9 months for the REDUCTION cohort and 12.4 ± 5.3 months for the conventional CT cohort. Mean estimated effective dose for all REDUCTION scans was 0.15 milliSieverts (mSv) as compared to 1.50 mSv for the conventional CT cohort (P = 0.037). Preoperative diagnosis was confirmed intraoperatively in 49/50 cases in the REDUCTION cohort compared with 48/50 cases in the conventional CT cohort (P = 0.79). Outcomes including time to union, range of motion, complications, readmission, treatment failure, reoperation, and length of stay were not significantly different between groups.

Conclusions:
The REDUCTION protocol represents ultralow-dose CT developed for minimizing radiation exposure to patients presenting with traumatic fractures. This protocol resulted in a 10-fold reduction in radiation exposure. No difference in clinical or hospital quality outcomes was detected between patients who received this protocol as compared to those receiving automated dose CT. The REDUCTION protocol is a safe and effective method of performing CT for extremity fractures with significantly reduced radiation risk.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.