Application of the Canadian Computed Tomography Head Rule to Patients With Minimal Head Injury

Davey, Kevin; Saul, Turandot; Russel, Geoffrey; Wassermann, J.; Quaas, Joshua

doi:10.1016/j.annemergmed.2018.03.034

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…One of the themes that emerged during our root-cause analysis was the inappropriate application of the CCTHR to patients with minimal head injuries (GCS score 15 and without loss of consciousness, amnesia or disorientation), instead of those with minor head injuries (GCS score 13–15, with loss of consciousness, amnesia or disorientation) 20. As such, the application of a clinical decision rule to a population with a lower pre-test probability of clinically significant injury would lead to an increase in the number of CT scans done without an improvement in detection rate and hence result in a higher false-positive rate 21.…”

Section: Strategymentioning

confidence: 99%

Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department

et al. 2020

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Over 90% of patients with head trauma seen in emergency departments (EDs) are diagnosed with minor head injuries. Over-utilisation of CT scans results in unnecessary exposure to radiation and increases healthcare utilisation. Using recommendations from the Choosing Wisely Canada (CWC) campaign and quality improvement (QI) methodology, we aimed to reduce the CT scan rate for head injuries by 10% over a 6-month period.Baseline CT scan rates were determined through a 27-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and Plan-Do-Study-Act (PDSA) cycles, which included (1) improving provider knowledge about the CWC campaign recommendations; (2) testing, refining and implementing a modified Canadian CT Head Rule checklist; (3) developing CWC-themed head injury–specific patient handouts; and (4) feedback on CT scan group ordering rates to providers. Our primary outcome measure was the number of CT scans performed for patients with head injuries. Process measures included the number of checklists completed and ED length of stay (LOS). Our balancing measure was return ED visits within 72 hours (with or without admission).Baseline CT scan rates prior to our interventions was 46.1%. Our QI initiative resulted in a ‘shift’ in the Statistical Process Control chart of the weekly CT scan rates, associated with the first and second PDSA cycles, resulting in a 13.9% reduction in CT rates during the initial 3 months, and a sustained reduction of 8% at 16 months (p<0.05). Mean ED LOS for all patients with head injuries decreased by 1.5 min (p=0.74). 33% of checklists were completed. 72-hour return visits did not change significantly (p=0.68).Through provider and patient education, and the creation of a user-friendly evidence-based tool, our local QI initiative was successful in achieving long-term reduction in CT rates for patients presenting to EDs with head injuries.

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Section: Strategymentioning

confidence: 99%

Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department

et al. 2020

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“…When CDM was operationalized as cognition, disposition decisions, or a model, studies overall found that an aid improved performance, in terms of decisions that are more accurate and lower uncertainty [21,38,40,[61][62][63][64][65][66][67][68].…”

Section: Effects Of Aidsmentioning

confidence: 99%

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

et al. 2020

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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Section: Effects Of Aidsmentioning

confidence: 99%

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Gamborg

Mehlsen

Paltved

et al. 2020

Preprint

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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Application of the Canadian Computed Tomography Head Rule to Patients With Minimal Head Injury

Cited by 20 publications

References 22 publications

Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department

Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

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