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

BACKGROUND: Defensive 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. METHODS: We 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. RESULTS: Four 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. CONCLUSION: Defensively ordered CT scan in the workup of trauma patients is a prevalent and costly practice that exposes patients to potentially unnecessary and harmful radiation. (C) 2015 Elsevier Inc. All rights reserved.