More than $17 billion may be spent annually in the U.S. on unnecessary imaging done in acute trauma cases, thereby exposing patients to unnecessary radiation, according to research presented at last month's annual meeting of the Radiological Society of North America (RSNA; Oak Brook, Illinois) in Chicago. John- athan Hadley, MD, a resident at Eastern Virginia Medical School (Norfolk, Virginia), studied 200 cases of trauma patients who received either computed tomography (CT) or computed radiography (CR) scans within the first three hours of arrival at a Level 1 trauma center. "About half of the patients, 52%, had no clinically significant injuries you could see radiographically, if you combine those cases where no injury was found with the cases where the patient sustained only minor injuries," Hadley said.

The 200 patients covered in the study received 660 CT exams and 429 CR exams. More than one-third (35%) had no radiographically identifiable injuries, and another 17% had minor injuries. "I tried to be as generous as possible when determining whether people should have been imaged," said Hadley. "If you apply the American College of Radiology's [ACR; Reston, Virginia] recommendations, you can eliminate unnecessary imaging in many patients not all, but most."

Hypothesizing that physicians in trauma settings may be driven to image more patients than necessary in order to "cover" themselves and avoid litigation, he said, "If you sit down and have an honest talk with clinicians about why they ordered imaging exams, they say that they don't expect there to be an injury but feel they need to cover their bases. A lawsuit can cost millions of dollars, but when you compare that to the CT costs for one patient, it makes the decision to do the exam more reasonable." However, Hadley said that when he looked at the larger picture, the figures were "staggering." Total imaging costs for the 200 patients he studied were $837,028, or an average cost per patient of $4,953. He said that multiplying that average by the ACR's estimate of 9 million trauma patients seen annually in the U.S., $45 billion is being spent on imaging alone. Applying the ACR "appropriateness" criteria, Hadley said he found a possible savings of just under $2,000 per patient, totaling about $17 billion a year.

The research also highlighted radiation exposure. Noting that the National Council on Radiation Protection and Measurements (Bethesda, Maryland) estimates patients receiving a 10 mSv dose of radiation later get cancer at a rate of 1 per 2,000, Hadley reported the average dose of radiation in his study was 16 mSv per patient. "Physicians could cut patients' risks of radiation exposure and cancer by half if they were more selective," he said. "The cases indicate it's not an insignificant amount of radiation. If money doesn't get attention, then maybe the potential risk of giving patients cancer will."

Gingrich faults Bush's lapse in IT effort

Newt Gingrich, former Speaker of the House and founder of the Center for Health Transformation (Washington), an organization that focuses on technological development for better healthcare, last month called on the administration of President George Bush to put its money where its mouth is. Gingrich was part of a panel discussion on healthcare challenges following the results of this year's election. He spoke at the Emerging Technologies and Healthcare Innovations Congress (TETHIC) in Washington, along with Rep. Tim Murphy (R-Pennsylvania).

The Bush administration, Gingrich said, is "at a real crossroads. I think it was taken to that crossroads by the decision of the Appropriations Committee to zero out David Brailer's office" Brailer was appointed in May as the government's first national coordinator for health information technology. And his appointment was part of a plan to promote adoption of electronic health records (EHRs) for Americans within a decade.

Congress, "in its wisdom," said Gingrich, "while spending over $300 billion in an omnibus appropriations bill, while spending $16 billion on specific projects in 12,000 line items, while spending $66 billion on Health and Human Services discretionary accounts, couldn't find $50 million to send a signal that David Brailer has a real job and a real assignment."

Brailer's office did not receive funding in the Omnibus Budget Act that was passed last month. His office originally was slated for $100 million in funding. That was reduced to $75 million, then $50 million, then $25 million. The final version of budget appropriations cut funding completely. Gingrich said, "Frankly, I think this is really a disgrace. This is the first real test for the administration after the election because they have reprogramming authority, and by reprogramming one-tenth of 1% of the discretionary [funding] at HHS, Secretary [Tommy] Thompson can fully fund David Brailer's office. It's that simple. It's not complicated."

He said, "Here is a president who has made more speeches on health information technology than all the other presidents in history combined. Here is a president who talked about electronic health records during the presidential debates. Now that's a fairly high level of commitment." And he said it is time for both the administration and the healthcare industry in general to take a different approach. He noted that the Institute of Medicine (IOM; Washington) reported between 45,000 and 100,000 Americans killed annually by medical mistakes.

He added: "If we are hit by a pandemic, you could easily lose a million Americans. If we are hit by an engineered pandemic, we could lose many more, if you had a biological engineer [who was] a terrorist or just a nut. The next Unibomber could be a biologist." If that were to happen, Gingrich said, the panel investigating that disaster would look back and ask why the U.S. had not built a virtual public health system.

He said there are four key tasks for the administration in the near future. The first, he said, is to reprogram the necessary discretionary funding to fully support Brailer's office. Second, he called upon the administration to fund "real information technology investment" in the 2006 budget. Third, he said the government should insist upon a "welcome to Medicare" physical that has an electronic health record. And finally, he said the government needs to get serious about funding information technology for doctors.

Gingrich said that if he "looks past" Washington, he is pretty optimistic. "There are a lot of initiatives around the country, and once these things start building, the momentum of replication is staggering." And he predicted: "The technology is coming. The bureaucracies may be slow and stupid, and the politicians may be avoiding reality, but in the end technology is going to get them there."

Group pushes for vascular surgery specialty

Using the analogy of a national election and nominating conventions, this year's VEITHsymposium might best be described providing a vocal nomination for recognition of vascular surgery as an independent specialty and thereby challenging the sector's more traditional approaches. This year's symposium in New York, the 31st overall, served to support its organizers' contention that vascular surgery deserves its own independent board approved by the American Board of Medical Specialties (Evanston, Illinois) by rolling out a formidable list of presenters touting the efficacy of the newest endovascular and minimally invasive vascular surgery strategies and patient benefits as compared to standard surgical approaches.

The argument for this independent recognition was recently backed by a Deloitte and Touche poll indicating that members of the Society for Vascular Surgery (SVS; Chicago) back such recognition. The survey said that 76% of its members representing 90% of vascular surgeons support the independent board.

Actively supporting the recognition is Frank Veith, MD, for whom the symposium is named and its host. The new interventional approaches in the field are applicable and safe for both lower risk as well as high-risk patients, he told The BBI Newsletter. He said the attempt at recognition by an American Board of Medical Specialties has been ongoing for "the last five or six years and we're still in the process of fighting it," the primary opposition coming from the American Board of Surgery.

Veith also was announced at the gathering as recipient of the first Julius H. Jacobson II, MD, Award for Physician Excellence, given by the Vascular Disease Foundation. Jacobson, a pioneer in the field of microscurgery, said that Veith's contribution "has been bringing about a globalization of vascular surgical knowledge to the profession." Apart from acknowledging the award, Veith reiterated pursuit of his goal that vascular surgery will be done "more and more by people just doing vascular surgery, not as a hobby or as a sideline." He added: "Unfortunately, we're locked in a struggle" to prevent the hobby/sideline approach.

Survey highlights children's asthma

Findings from one of the nation's largest and most comprehensive surveys about children and asthma to date, "Children and Asthma in America," reveal that more than half (54%) of all children with asthma had a severe asthma attack in the past year and more than one-quarter (27%) had an asthma attack so bad they thought their life was in danger. The survey results underscore the severity of asthma in children in the U.S. and the significant impact the disease has on children and their families.

Presented on behalf of Asthma Action America, the survey findings suggest the U.S. is falling far short of the national treatment goals established for asthma, and indicate that the majority of children with asthma do not have it under control. This places children at potential risk for a variety of consequences, including frequent symptoms, missed school, restrictions on activities, emotional distress, hospitalization and even life-threatening asthma attacks. An estimated 5.8 million U.S. children, ages 4 to 18, currently have the condition, making it one of the most common chronic illnesses among this group.

"These are disturbing findings, especially since asthma is a highly controllable disease," said William Sears MD, pediatrician and associate clinical professor of pediatrics at the University of California Irvine School of Medicine. "We need to help parents recognize that proper asthma control means children are symptom-free all or most of the time."

The survey was conducted by Schulman, Ronca and Bucuvalas (SRBI; New York), a national research firm specializing in health issues, and it was released on behalf of Asthma Action America, a national asthma education campaign supported by organizations working on improving asthma care in the U.S. It was funded by GlaxoSmithKline (London).

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