Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 5-6/2017

01.03.2017 | original article

Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need

verfasst von: M.D. M.S.C.S. Ph.D. Lukas Lambert, Ondrej Foltan, Jan Briza, Alena Lambertova, Pavel Harsa, Rohan Banerjee, Jan Danes

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2017

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent.

Aim

To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years.

Methods

We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations.

Results

The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = −0.88, p = 0.0001), the proportion of important findings on cranial CT (r = −0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = −0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062).

Conclusions

The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.
Literatur
1.
Zurück zum Zitat Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Eng J Med. 2007;357(22):2277–84. CrossRef Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Eng J Med. 2007;357(22):2277–84. CrossRef
2.
Zurück zum Zitat Coco AS, O’Gurek DT. Increased emergency department computed tomography use for common chest symptoms without clear patient benefits. J Am Board Fam Med. 2012;25(1):33–41. CrossRefPubMed Coco AS, O’Gurek DT. Increased emergency department computed tomography use for common chest symptoms without clear patient benefits. J Am Board Fam Med. 2012;25(1):33–41. CrossRefPubMed
3.
Zurück zum Zitat Hess EP, Haas LR, Shah ND, Stroebel RJ, Denham CR, Swensen SJ. Trends in computed tomography utilization rates: a longitudinal practice-based study. J Patient Saf. 2014;10(1):52–8. CrossRefPubMed Hess EP, Haas LR, Shah ND, Stroebel RJ, Denham CR, Swensen SJ. Trends in computed tomography utilization rates: a longitudinal practice-based study. J Patient Saf. 2014;10(1):52–8. CrossRefPubMed
4.
Zurück zum Zitat Lee J, Evans CS, Singh N, et al. Head computed tomography utilization and intracranial hemorrhage rates. Emerg Radiol. 2012;20(3):219–23. CrossRefPubMed Lee J, Evans CS, Singh N, et al. Head computed tomography utilization and intracranial hemorrhage rates. Emerg Radiol. 2012;20(3):219–23. CrossRefPubMed
5.
Zurück zum Zitat Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency department computed tomography utilization in the united states and canada. Ann Emerg Med. 2013;62(5):486–494.e3. CrossRefPubMed Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency department computed tomography utilization in the united states and canada. Ann Emerg Med. 2013;62(5):486–494.e3. CrossRefPubMed
6.
Zurück zum Zitat Fung Kon Jin PHP, Dijkgraaf MGW, Alons CL, et al. Improving CT scan capabilities with a new trauma workflow concept: Simulation of hospital logistics using different CT scanner scenarios. Eur J Radiol. 2011;80(2):504–9. CrossRefPubMed Fung Kon Jin PHP, Dijkgraaf MGW, Alons CL, et al. Improving CT scan capabilities with a new trauma workflow concept: Simulation of hospital logistics using different CT scanner scenarios. Eur J Radiol. 2011;80(2):504–9. CrossRefPubMed
7.
Zurück zum Zitat Körner M, Geyer LL, Wirth S, Reiser MF, Linsenmaier U. 64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow. AJR Am J Roentgenol. 2011;197(3):W399–404. CrossRefPubMed Körner M, Geyer LL, Wirth S, Reiser MF, Linsenmaier U. 64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow. AJR Am J Roentgenol. 2011;197(3):W399–404. CrossRefPubMed
8.
Zurück zum Zitat Glaser C, Trumm C, Nissen-Meyer S, Francke M, Küttner B, Reiser M. Spracherkennung: Auswirkung auf Workflow und Befundverfügbarkeit. Radiologe. 2005;45(8):735–42. CrossRefPubMed Glaser C, Trumm C, Nissen-Meyer S, Francke M, Küttner B, Reiser M. Spracherkennung: Auswirkung auf Workflow und Befundverfügbarkeit. Radiologe. 2005;45(8):735–42. CrossRefPubMed
9.
Zurück zum Zitat Kirsch TD, Hsieh Y‑H, Horana L, Holtzclaw SG, Silverman M, Chanmugam A. Computed tomography scan utilization in emergency departments: a multi-state analysis. J Emerg Med. 2011;41(3):302–9. CrossRefPubMed Kirsch TD, Hsieh Y‑H, Horana L, Holtzclaw SG, Silverman M, Chanmugam A. Computed tomography scan utilization in emergency departments: a multi-state analysis. J Emerg Med. 2011;41(3):302–9. CrossRefPubMed
10.
Zurück zum Zitat Müller K, Townend W, Biasca N, et al. S100B serum level predicts computed tomography findings after minor head injury. J Trauma. 2007;62(6):1452–6. CrossRefPubMed Müller K, Townend W, Biasca N, et al. S100B serum level predicts computed tomography findings after minor head injury. J Trauma. 2007;62(6):1452–6. CrossRefPubMed
11.
Zurück zum Zitat Studdert DM, Mello MM, Sage WM, et al. Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. JAMA. 2005;293(21):2609–17. CrossRefPubMed Studdert DM, Mello MM, Sage WM, et al. Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. JAMA. 2005;293(21):2609–17. CrossRefPubMed
12.
Zurück zum Zitat Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National Trends in Use of Computed Tomography in the Emergency Department. Ann Emerg Med. 2011;58(5):452–462.e3. CrossRefPubMed Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National Trends in Use of Computed Tomography in the Emergency Department. Ann Emerg Med. 2011;58(5):452–462.e3. CrossRefPubMed
13.
Zurück zum Zitat Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf. 2012;38(11):483–9. CrossRefPubMed Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf. 2012;38(11):483–9. CrossRefPubMed
15.
Zurück zum Zitat Bautista AB, Burgos A, Nickel BJ, Yoon JJ, Tilara AA, Amorosa JK. Do clinicians use the american college of radiology appropriateness criteria in the management of their patients? AJR Am J Roentgenol. 2009;192(6):1581–5. CrossRefPubMed Bautista AB, Burgos A, Nickel BJ, Yoon JJ, Tilara AA, Amorosa JK. Do clinicians use the american college of radiology appropriateness criteria in the management of their patients? AJR Am J Roentgenol. 2009;192(6):1581–5. CrossRefPubMed
16.
Zurück zum Zitat Ahn S, Kim WY, Lim KS, et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLOS ONE. 2014;9(11):e112650. CrossRefPubMedPubMedCentral Ahn S, Kim WY, Lim KS, et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLOS ONE. 2014;9(11):e112650. CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Menoch MJA, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics. 2012;129(3):e690–7. CrossRefPubMed Menoch MJA, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics. 2012;129(3):e690–7. CrossRefPubMed
18.
Zurück zum Zitat Stiell IG, Wells GA, Vandemheen K, et al. The canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6. CrossRefPubMed Stiell IG, Wells GA, Vandemheen K, et al. The canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6. CrossRefPubMed
19.
Zurück zum Zitat Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK. Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. Australas Med J. 2015;8(7):235–8. CrossRefPubMedPubMedCentral Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK. Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. Australas Med J. 2015;8(7):235–8. CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Wolf H, Machold W, Frantal S, et al. Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the canadian CT head rule. J Neurosurg. 2014;120(2):447–52. CrossRefPubMed Wolf H, Machold W, Frantal S, et al. Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the canadian CT head rule. J Neurosurg. 2014;120(2):447–52. CrossRefPubMed
23.
Zurück zum Zitat Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5. CrossRefPubMed Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5. CrossRefPubMed
24.
Zurück zum Zitat Gittleman AM, Ortiz AO, Keating DP, Katz DS. Indications for CT in patients receiving anticoagulation after head trauma. Am J Neuroradiol. 2005;26(3):603–6. PubMed Gittleman AM, Ortiz AO, Keating DP, Katz DS. Indications for CT in patients receiving anticoagulation after head trauma. Am J Neuroradiol. 2005;26(3):603–6. PubMed
26.
Zurück zum Zitat Raja AS, Ip IK, Sodickson AD, et al. Radiology utilization in the emergency department: trends of the past 2 decades. AJR Am J Roentgenol. 2014;203(2):355–60. CrossRefPubMedPubMedCentral Raja AS, Ip IK, Sodickson AD, et al. Radiology utilization in the emergency department: trends of the past 2 decades. AJR Am J Roentgenol. 2014;203(2):355–60. CrossRefPubMedPubMedCentral
Metadaten
Titel
Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need
verfasst von
M.D. M.S.C.S. Ph.D. Lukas Lambert
Ondrej Foltan
Jan Briza
Alena Lambertova
Pavel Harsa
Rohan Banerjee
Jan Danes
Publikationsdatum
01.03.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 5-6/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-1025-6