Overuse of brain CT scan for evaluating mild head trauma in adults

Shobeirian, Farzaneh; Ghomi, Zahra; Soleimani, Reza; Mirshahi, Reza; Taheri, Morteza Sanei

doi:10.1007/s10140-020-01846-6

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…Interestingly, our study found young patients aged between 21 and 30 to have the highest overuse of CT head imaging, with the second highest in patients between 31 and 40. Data from the study by Shobeirian et al correlate with our findings in this aspect; they reported 34% of overuse in young patients compared to 20.3% in our study [ 18 ]. Another study by Cellina et al, conducted exclusively on patients aged 18-45, evaluating a total of 493 CT scans, observed an overuse of 72%.…”

Section: Discussionsupporting

confidence: 91%

“…Two studies that utilized the CCHR reported a higher percentage of CT overuse compared to our study. The paper by Shobeirian et al in Iran, assessing 170 adult patients with mild head trauma, reported 31.8% of CT head imaging overuse when referring to the CCHR [ 18 ]. Another analysis of CT overuse in minor traumatic brain injury by Melnick et al, assessing 346 adult patients, reported an even higher percentage (35%) of CT overuse [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Computed Tomography Overuse for Mild Head Injury in Adults

Omran¹,

Patil²,

Anala³

et al. 2023

Cureus

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Introduction: The Canadian CT Head Rule (CCHR) is one of many established guidelines for assessing the need for computed tomography (CT) imaging in patients with minor head injuries. Adhering to such criteria would promote the appropriate use of CT imaging, lower healthcare expenses, and prevent harmful radiation exposure. There is no current literature assessing the overuse of CT imaging for minor head injuries in the Kingdom of Bahrain. This study aims to evaluate CT overuse in adult patients with minor head trauma.Methods: The study was conducted at the Bahrain Defense Force Hospital over 12 months from January to December 2021. All adult patients (>14 years) who sustained a minor head injury and were referred to the emergency department for CT brain imaging were included in the study. Patients presenting for other reasons or suffering from moderate to severe head injuries were excluded. CT reports were retrieved for analysis. The CCHR was used as a reference.Results: A total of 486 CT scans were performed. Loss of consciousness was the most common symptom on presentation (n = 74 cases). Only 12.1% of CT scans reported positive findings. The prevalence of CT overuse was highest in patients aged 21-30 years. Patients presenting with loss of consciousness showed a high overuse of CT imaging, accounting for 20.3% of all cases. Only 77.4% of cases met the CCHR criteria and 22.6% were defined as overuse, with 95% confidence interval (0.189, 0.266). Conclusion:When referring to the CCHR, CT imaging for a minor head injury in adults was overused in 22.6% of cases. Further research will be required to reveal the underlying reasons for these findings along with interventions to reduce future overuse.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Prevalence of Computed Tomography Overuse for Mild Head Injury in Adults

Omran¹,

Patil²,

Anala³

et al. 2023

Cureus

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“…To date, patients with TBI have been shown to benefit from brain CT scans, and several decision-making algorithms for performing CT scans based on clinical conditions have been developed, e.g., Canadian CT Head Rule (CCHR) and NICE [9][10]. Although CT scans are beneficial in patients with TBI, CT scans expose the patient to X-rays and cost the patient and the health system economically [11][12]. Also, the unavailability of CT scans in remote or deprived areas, especially in developing countries, is another challenge that emergency medicine specialists confront [13].…”

Section: Opinionmentioning

confidence: 99%

Traumatic Brain Injury and Adherence of Physicians to Brain Trauma Foundations Guidelines

Dehghan¹

2021

Curr Res Emerg Med

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“…Overtesting may result from intrapersonal (eg, fear of litigation, risk aversion, intolerance of uncertainty), interpersonal (eg, pressure from patients and colleagues) or contextual (eg, guidelines, financial incentives, time constraints, test availability) factors 7. Studies in different countries have shown that over 10% of CT scans reflect overtesting,8 9 indicating substantial room for improvement in this area.…”

Section: Introductionmentioning

confidence: 99%

Association of regulatory body actions and subsequent media coverage with use of services in a fee-for-service system: a longitudinal cohort study of CT scanning in Australia

Youens

Doust

et al. 2022

BMJ Open

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ObjectiveThe professional service review (PSR) is an Australian Government agency aiming to reduce inappropriate practices funded via Medicare, Australia’s public insurer. Our objective was to examine changes in CT following the 2008–2009 PSR annual report, which noted excessive CT use.DesignInterrupted time series analysis examined trends in CT use following the 2008–2009 PSR report, estimating both change in the immediate rate of CT and the slope of the trend in usage postintervention.SettingMedicare-funded imaging (most out-of-hospital imaging) in Australia.ParticipantsPatients receiving Medicare-funded CT and other imaging.InterventionThe 2008–2009 PSR report highlighted concerns regarding excessive CT use. Two providers were financially penalised for CT overuse with these cases detailed in the PSR report and highlighted in an associated Report to the Professions, distributed to 50 000 providers. Media articles on radiation risks followed.OutcomesQuarterly rates of out-of-hospital CT, MRI (as a comparator), and all other Medicare-funded diagnostic imaging examinations 2001–2019.ResultsCT scanning increased from 4663.5 per 100 000 person-years in 2001 to 14 506 in 2019 (211% increase), with substantial variation by type and anatomical region. The 2008–2009 PSR report was followed by an immediate reduction in CT scanning of 237.7 CTs per 100 000 people per quarter (95% CI −333.4 to −141.9) though growth in use soon continued at the preintervention rate. The degree of change in utilisation following the report differed between states/territories and by scan type, both in terms of the immediate change and the slope. For other diagnostic imaging modalities, there was an increase in the slope, while for MRI there was no change in either parameter.ConclusionActions consisting of financial disincentives for service overtesting and provider/public education components may limit excessive use of diagnostic imaging in fee-for-service systems, however, effects observed here were only short lived.

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Overuse of brain CT scan for evaluating mild head trauma in adults

Cited by 17 publications

References 26 publications

Prevalence of Computed Tomography Overuse for Mild Head Injury in Adults

Prevalence of Computed Tomography Overuse for Mild Head Injury in Adults

Traumatic Brain Injury and Adherence of Physicians to Brain Trauma Foundations Guidelines

Association of regulatory body actions and subsequent media coverage with use of services in a fee-for-service system: a longitudinal cohort study of CT scanning in Australia

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