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

Sharp, Adam L.; Nagaraj, Ganesh; Rippberger, Ellen J.; Shen, Ernest; Swap, Clifford J.; Silver, Matthew; McCormick, Taylor; Vinson, David R.; Hoffman, Jerome R.

doi:10.1111/acem.13061

Cited by 51 publications

(62 citation statements)

References 32 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is also promising that the modest reductions in CT use observed here in community settings were similar to those observed at academic-based Level I trauma centers. 8,9,11,23,24 However, our findings differ from those of a similar study of Canadian CT Head Rule implementation in Canada, which found a negative or null effect on CT use. 10 This may be a result of differences in the patient populations, medical cultures, physician training, or other variation between US and Canadian health care systems.…”

Section: Discussioncontrasting

confidence: 99%

“…8,9 Among studies reporting use of clinical decision rules, including the Canadian CT Head Rule, findings have been mixed. Some studies show no change, whereas others show increased imaging use 10 without eliminating unwarranted imaging or increasing diagnostic yield 5,11,12 despite expectations that Canadian CT Head Rule adherence will substantially decrease CT use.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies show no change, whereas others show increased imaging use 10 without eliminating unwarranted imaging or increasing diagnostic yield 5,11,12 despite expectations that Canadian CT Head Rule adherence will substantially decrease CT use. 8,9,11 …”

Section: Introductionmentioning

confidence: 99%

“…9 The purpose of this study was to evaluate the association of implementing the Canadian CT Head Rule on rates of head CT use among adult ED trauma patients. Our secondary objective was to examine the association of clinical decision rule implementation with diagnostic yield, or the proportion of CT studies that identified radiographically significant brain injuries, given our goal to increase imaging appropriateness as opposed to solely reducing use.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Implementation of the Canadian CT Head Rule and Its Association With Use of Computed Tomography Among Patients With Head Injury

Sharp

Huang

Tang

et al. 2018

Annals of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Study objective Approximately 1 in 3 computed tomography (CT) scans performed for head injury may be avoidable. We evaluate the association of implementation of the Canadian CT Head Rule on head CT imaging in community emergency departments (EDs). Methods We conducted an interrupted time-series analysis of encounters from January 2014 to December 2015 in 13 Southern California EDs. Adult health plan members with a trauma diagnosis and Glasgow Coma Scale score at ED triage were included. A multicomponent intervention included clinical leadership endorsement, physician education, and integrated clinical decision support. The primary outcome was the proportion of patients receiving a head CT. The unit of analysis was ED encounter, and we compared CT use pre- and postintervention with generalized estimating equations segmented logistic regression, with physician as a clustering variable. Secondary analysis described the yield of identified head injuries pre- and postintervention. Results Included were 44,947 encounters (28,751 preintervention and 16,196 postintervention), resulting in 14,633 (32.6%) head CTs (9,758 preintervention and 4,875 postintervention), with an absolute 5.3% (95% confidence interval [CI] 2.5% to 8.1%) reduction in CT use postintervention. Adjusted pre-post comparison showed a trend in decreasing odds of imaging (odds ratio 0.98; 95% CI 0.96 to 0.99). All but one ED reduced CTs postintervention (0.3% to 8.7%, one ED 0.3% increase), but no interaction between the intervention and study site over time existed (P=.34). After the intervention, diagnostic yield of CT-identified intracranial injuries increased by 2.3% (95% CI 1.5% to 3.1%). Conclusion A multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implementation of the Canadian CT Head Rule and Its Association With Use of Computed Tomography Among Patients With Head Injury

Sharp

Huang

Tang

et al. 2018

Annals of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…As we discussed in our original article, we used a hybrid design in an attempt to capitalize on the strengths, and compensate for the limitations, inherent to each strategy. 3 We believe that our methodology allowed our findings to be reliably applied to a group of more than 27,000 encounters in community EDs; we trust readers to decide for themselves whether or not this adds value to the 100 included in our chart review or the referenced study of 346 encounters in an academic Level I trauma center. 1 Dr. Melnick also expresses concern about the lack of a power calculation in our study.…”

mentioning

confidence: 91%

In Reply:

Sharp

2017

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia

Harris

Bulsara

et al. 2023

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose Whilst computed tomography (CT) imaging has been a vital component of injury management, its increasing use has raised concern regarding ionising radiation exposure. This study aims to identify latent classes (underlying patterns) of CT use over a 3-year period following the incidence of injury and factors predicting the observed patterns. Method A retrospective observational cohort study was conducted in 21,544 individuals aged 18 + years presenting to emergency departments (ED) of four tertiary public hospitals with new injury in Western Australia. Mixture modelling approach was used to identify latent classes of CT use over a 3-year period post injury. Results Amongst injured people with at least one CT scan, three latent classes of CT use were identified including a: temporarily high CT use (46.4%); consistently high CT use (2.6%); and low CT use class (51.1%). Being 65 + years or older, having 3 + comorbidities, history with 3 + hospitalisations and history of CT use before injury were associated with consistently high use of CT. Injury to the head, neck, thorax or abdomen, being admitted to hospital after the injury and arriving to ED by ambulance were predictors for the temporarily high use class. Living in areas of higher socio-economic disadvantage was a unique factor associated with the low CT use class. Conclusions Instead of assuming a single pattern of CT use for all patients with injury, the advanced latent class modelling approach has provided more nuanced understanding of the underlying patterns of CT use that may be useful for developing targeted interventions.

show abstract

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

Abstract: Background: Millions of head computed tomography (CT) scans are ordered annually, but the extent of

Cited by 51 publications

References 32 publications

Implementation of the Canadian CT Head Rule and Its Association With Use of Computed Tomography Among Patients With Head Injury

Implementation of the Canadian CT Head Rule and Its Association With Use of Computed Tomography Among Patients With Head Injury

In Reply:

Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia

Contact Info

Product

Resources

About