Evaluating blunt abdominal trauma with sonography: A cost analysis

Ultrasonography (US) is becoming increasingly utilized in the United States for the evaluation of blunt abdominal trauma (BAT). The objective of this study was to assess the cost impact of utilizing US in the evaluation of pa tients with BAT in a major trauma center. All patients sustaining BAT durin g a 6-month period before US was used at our institution (Jan-Jun 1993) wer e compared to BAT patients from a recent period in which US has been utiliz ed (Jan-Jun 1995). The numbers of US, computed tomography (CT), and diagnos tic peritoneal lavage (DPL) were tabulated for each group. Financial cost f or each of these procedures as determined by our finance department were as follows: US $96, CT $494, DPL $137. These numbers are representative of ac tual hospital expenditures exclusive of physician fees as calculated in 199 4 U.S. dollars. Cost analysis was performed with t test and chi squared tes t, and significance was defined as P < 0.05. There were 890 BAT admissions in the 1993 study period and 1033 admissions in the 1995 study period. Duri ng the 1993 period, 642 procedures were performed on the 890 patients to ev aluate the [GRAPHICS] abdomen: 0 US, 466 CT, and 176 DPL (see table). This compares to 801 proced ures on the 1033 patients in 1995: 552 US, 228 CT, and 21 DPL. Total cost w as $254,316 for the 1993 group and $168,501 for the 1995 group. Extrapolate d to a 1-year period, a significant (P < 0.05) cost savings of $171,630 wou ld be realized. Cost per patient evaluated was significantly reduced from $ 285.75 in 1993 to $163.12 in 1995 (P < 0.05). This represents a 43 per cent reduction in per patient expenditure for evaluating the abdomen. By effect ively utilizing ultrasonography in the evaluation of patients with blunt ab dominal trauma, a significant cost savings can be realized. This effect res ults chiefly from an eight-fold reduction in the use of DPL, and a two-fold reduction in the use of CT.