The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study

• Prospective, observational study characterizing defensive medicine in the workup of trauma patients.
• Reflexively ordered CT scans in trauma activation patients are a prevalent and costly practice.
• These scans also expose patients to potentially unnecessary and harmful radiation.

BackgroundDefensive medicine is estimated to cost the United States $210 billion annually. Trauma surgeons are at risk of practicing defensive medicine in the form of reflexively ordering computed tomography (CT) scans. The aim of this study is to quantify the monetary impact and radiation exposure related to the radiographic workup of trauma patients.MethodsWe conducted a prospective, observational study involving 295 trauma patients at Level I trauma center. Physicians were surveyed regarding specific CT scans ordered, likelihood of significant injuries found on scans, and which scans would have been ordered in a hypothetical, litigation-free environment.ResultsFour hundred sixteen of 1,097 CT scans (38%) were ordered out of defensive purposes. Nine CT scans (2.2%) that would not have been ordered resulted in a change in management. Defensively ordered CT scans resulted in nearly $120,000 in excess charges and 8.8 mSv of unnecessary radiation per patient.ConclusionDefensively ordered CT scan in the workup of trauma patients is a prevalent and costly practice that exposes patients to potentially unnecessary and harmful radiation.