Computed Tomography Use for Adults With Head Injury: Describing Likely Avoidable Emergency Department Imaging Based on the Canadian CT Head Rule

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

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Use of Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Computed Tomography Findings of Increased Intracranial Pressure in Adult Head Injury Patients

Academic Emergency Medicine ◽

10.1197/j.aem.2005.03.392 ◽

2005 ◽

Vol 12 (Supplement 1) ◽

pp. 139-139

Author(s):

M. Neulander

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Optic Nerve ◽

Head Injury ◽

Intracranial Pressure ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Increased Intracranial Pressure ◽

Nerve Sheath ◽

Adult Head

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Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

CJEM ◽

10.2310/8000.2012.120597 ◽

2013 ◽

Vol 15 (03) ◽

pp. 161-166 ◽

Cited By ~ 1

Author(s):

Deljit Dhanoa ◽

Kirsteen Rennie Burton ◽

Lyne Noël de Tilly ◽

Ravi J. Menezes

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Control Group ◽

Head Group ◽

Ct Utilization ◽

Noncontrast Ct ◽

Ct Head ◽

After Hours ◽

The Impact ◽

Ct Studies

ABSTRACTObjective:To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT).Methods:All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies.Results:During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (pvalue = 0.061 for a difference between groups).Conclusion:Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policiesmay be unfounded, and further research in this area is warranted.

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