Reduced Need for Dedicated Computed Tomography With Implementation of a New Temporal Bone Fracture Protocol

Introduction: Temporal bone computed tomography (TBCT) is used to evaluate temporal bone fractures, but on average, it can result in an additional 88 mGy of radiation exposure and an extra $1,520 in cost without clear clinical benefit. This study aimed to determine whether a new protocol could decrease the need for dedicated TBCT without impacting temporal bone fracture management.

Methods: Retrospective review of patients sustaining temporal bone fractures at a level I trauma center from January 1, 2019 to January 1, 2024 was completed before and after implementation of a new protocol to reconstruct 0.625 mm thick images at 0.3 mm spacing TBCT from existing CT head instead of the immediate performance of TBCT (IRB H-44161). Primary outcomes included the need for dedicated TBCT and treatment and the incidence of otologic complications.

Results: During the study period, 17 of 69 patients who sustained temporal bone fractures were evaluated after protocol implementation. After implementation, patients had significantly lower odds of needing dedicated TBCT (OR = 0.077, 95% CI 0.0158, 0.3726, p = 0.0002) with no significant differences in medical (p = 0.5385) or surgical management (p = 1). Otic capsule involvement (p = 0.3110) and otologic complications, including cerebrospinal fluid leak, facial nerve paresis, or hearing loss (p = 1), also did not differ significantly.

Conclusions: A new protocol to reconstruct TBCT from previously obtained head CT scans has reduced the need for dedicated TBCT without differences in management or complication, reducing radiation exposure and decreasing healthcare costs.