Overuse of Head CT Examinations for the Investigation of Minor Head Trauma: Analysis of Contributing Factors

Klang, Eyal; Beytelman, Arkadi; Greenberg, Dan; Or, Jacob; Guranda, Larisa; Konen, Eli; Zimlichman, Eyal

doi:10.1016/j.jacr.2016.08.032

Cited by 44 publications

(26 citation statements)

References 14 publications

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“…They found that the sensitivity and NPV of the modified CCHR were both 100% for detecting brain hemorrhages, skull fractures, and face fractures. 6 The current study revealed that the sensitivity, specificity, PPV, and NPV were 92%, 91%, 90%, and 92% for patients with the modified CCHR, including facial fractures.…”

Section: Discussionmentioning

confidence: 57%

“…3,4 The high incidence rates of minor head injuries are significant not only due to their long-term neurological impact on patients but also because of the substantial economic burden they place on healthcare services and the society. 5,6 Non-contrast head computed tomography (CT) has become the standard imaging method to detect brain injuries in patients with head traumas. 7 CT is a fast and highly sensitive technique for the detection of acute brain hemorrhages and skull fractures 1,8 and costs less than magnetic resonance imaging.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

Kızılgöz

Avcı

Sivrioğlu

et al. 2019

MNJ

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Background: Head computed tomography (CT) scans, which provide reliable information to assessor rule out neurological abnormalities and injuries, should be used judiciously to minimize radiation exposure and cost. Objective: The aim of this study was to evaluate the widely used Canadian CT Head Rule (CCHR) to determine the necessity of head CT scans in patients with minor head trauma. Methods: This retrospective study included 913 patients with head trauma who were admitted to Harakani State Hospital between June 2014 and December 2017. The patient data were reevaluated according to CCHR and compared with the radiological findings. Results: There were a total of 556 patients fulfilling the inclusion criteria with a male/female ratio of 2.95 and a mean age of 37 ± 4.24 years. The most common injury mechanism of head trauma was motor vehicle accidents. Chi square tests were applied for statistical calculations. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CCHR were 93%, 88%, 88%, 94%, and 90%, respectively. Conclusion: CCHR was highly useful for patients with minor head trauma who could benefit from head CT evaluation with high sensitivity and specificity.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

Kızılgöz

Avcı

Sivrioğlu

et al. 2019

MNJ

View full text Add to dashboard Cite

show abstract

“…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][13][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][17][18][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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“…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)(13)(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)(17)(18)(19). As such, for the management of these children, PED physicians should better evaluate the need for CT imaging for ciTBI identi cation in order to limit radiation exposure and optimize resource utilization (20).…”

mentioning

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

Sawaya

Wakil

Wazir

et al. 2020

Preprint

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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 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 Head CT Examinations for the Investigation of Minor Head Trauma: Analysis of Contributing Factors

Cited by 44 publications

References 14 publications

Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

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

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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