Overuse of computed tomography for minor head injury in young patients: an analysis of promoting factors

Cellina, Michaela; Panzeri, Marta; Floridi, Chiara; Martinenghi, C; Clesceri, Giulio; Oliva, Giancarlo

doi:10.1007/s11547-018-0871-x

Cited by 22 publications

(24 citation statements)

References 31 publications

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“…Low-value imaging of the brain was explored in 49 studies [ 20 – 66 ]. Specifically, routine use of head CT or repeat head CT in minor head injury and brain MRI were reported to be low-value for many clinical indications and conditions.…”

Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…Los pacientes con GCS de 13 tienen 25% de probabilidad de presentar una lesión significativa en la TC de cráneo, solamente 0.7% a 12% de los pacientes con GCS de 15 presentarán lesiones y solo entre 1% a 1,4% requerirán neurocirugía (8,(13)(14)(15) . La variabilidad en estos porcentajes en los distintos estudios se debe a que hay una mayor proporción de tomografías con lesiones significativas, cuando se realizan selectivamente.…”

Section: Introductionunclassified

Tomografía computarizada en traumatismo craneoencefálico leve, ¿son estas necesarias en todos los casos?

Milanesi

Suarez

Tafernaberry

et al. 2021

Rev. urug. med. interna

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Introduction. The systematic performance of skull tomography in mild brain trauma is controversial, corresponding to 70-90% of cases. Up to 10% of these traumas will present injuries and 1.4% will require neurosurgery. The objective of the study is to determine the number of pathological scans in mild head injury and to identify predictive factors for injury. Materials and methods. Observational, prospective, analytical study. Consultations for mild brain injury were identified between July 30, 2018 and August 15, 2019. The presence of risk factors for injury was assessed as the Glasgow coma scale at admission and at 2 hours, trauma kinematics, suspicion of skull base and vault fracture, headache, vomiting, people over 65 years of age, loss of consciousness, amnesia of the episode, anticoagulation or antiplatelet therapy and alcohol or drug use. The cases with pathological tomography and the need for neurosurgery were consigned. Results. 1,319 patients were included, 9% of pathological studies and 1.2% required neurosurgery. The high kinematics of trauma were significant as risk factors (p 0.02); Glasgow coma scale at 2 hours (p 0.014); suspicion of fracture of the vault (p 0.003) and skull base (p 0.000); vomiting on more than two occasions (p 0.000); headache (p 0.01) and episode amnesia (p 0.012). Conclusions. The identification of predictive factors of injury helps to optimize the use

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“…However, the use of diagnostic radiation has been associated with an increased risk of cancer in children, whose tissues are more susceptible to radiation-related cancer than adults [ 10 , 11 ]. Moreover, the overuse [ 12 – 14 ] and variability [ 15 , 16 ] in CT imaging of children with head trauma between clinicians and hospitals appear to be unrelated to the frequency of positive CT scans and ciTBI [ 4 , 16 – 19 ]. As such, for the management of these children, PED physicians should better evaluate the need for CT imaging for ciTBI identification in order to limit radiation exposure and optimize resource utilization [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

et al. 2020

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Background Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to December 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into < 2 and ≥ 2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p = 0.18). Among patients < 2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p = 0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p = 0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p = 0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged < 2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

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Overuse of computed tomography for minor head injury in young patients: an analysis of promoting factors

Abstract: We observed an important overuse of head CT scans in MHI; the main promoting factor for inappropriate was injury mechanism. 2% of head CT were positive, correlating with signs of suspected skull fracture and motor vehicle accident with high energy impact.

Cited by 22 publications

References 31 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Tomografía computarizada en traumatismo craneoencefálico leve, ¿son estas necesarias en todos los casos?

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

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