The cost-effectiveness of diagnostic management strategies for adults with minor head injury

Holmes, M; Goodacre, Steve; Stevenson, M; Pandor, Abdullah; Pickering, A

doi:10.1016/j.injury.2011.07.017

Cited by 34 publications

(35 citation statements)

References 22 publications

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“…Head trauma is a dynamic process and frequent examinations of such patients are necessary; the liberal use of brain CT scans at our trauma center appears to be justified. 9 Our results indicate that additional factors besides GCS score should be incorporated in the protocol to identify such patients. Further studies are required to determine whether additional factors for TPA would increase the total number of patients with trivial injury included and thus waste precious medical resources.…”

Section: Discussionmentioning

confidence: 75%

Evaluation of a revised in-hospital trauma activation protocol according to clinical outcome for patients with major trauma

Hsu

Hsiao

et al. 2013

Formosan Journal of Surgery

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Purpose: Timely trauma care is crucial, especially for severely injured patients. We developed a set of criteria based on physiological changes, anatomic regions injured, and trauma mechanisms in our hospital to identify these patients. This study was performed to examine whether or not our revised activation protocol was strictly followed, and to identify areas of deficiency for ongoing quality improvement. The impact of the activation protocol on clinical outcome was also examined. Methods: We reviewed demographic data, mechanisms of injury, trauma scores, and outcome for all trauma patients admitted to a Level I trauma center in southern Taiwan between October 2010 and October 2011. All trauma protocol activation (TPA) decisions were subjected to careful scrutiny. Clinical outcomes for TPA patients and for non-TPA patients who fulfilled the activation criteria were compared. We also analyzed data for patients who did not meet our activation criteria but were found on subsequent work-up to have an Injury Severity Score (ISS) !16. Results: During Phase I of the study there were 2988 trauma admissions. The overall accuracy for TPA was 95.9%. Among 281 TPA patients, only 181 (64.4%) fulfilled the activation criteria. Among 204 patients who met the activation criteria, the protocol was not activated for 23 (11.3%). After we redesigned the computer program to prompt triage nurses and reeducated healthcare personnel, the false TPA and non-TPA rates improved to 14.6% and 2.8%, respectively, during Phase II of the study. There were 187 patients who did not meet our activation criteria and had ISS ! 16. TPA patients had a significantly lower Glasgow Coma Scale (GCS) score and were more likely to be admitted to the intensive care unit than non-TPA

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Section: Discussionmentioning

confidence: 75%

Evaluation of a revised in-hospital trauma activation protocol according to clinical outcome for patients with major trauma

Hsu

Hsiao

et al. 2013

Formosan Journal of Surgery

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“…160 Uncertainty about the relative distribution of these three outcomes was represented using a Dirichlet distribution. These results are shown in Table 39 and use data in Holmes et al 161 A GOS state of 2 is associated with a severely reduced life expectancy. This was taken into account in the model by replicating an assumption in Holmes et al, 161 reducing the life expectancy to 3.4 years where it was otherwise expected to be greater.…”

Section: Initial Stagementioning

confidence: 70%

Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation

Simpson

Stevenson²,

Scope³

et al. 2013

Health Technol Assess

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“…Therefore, you are safe to clean and dress the facial wound and discharge him back to the care home. Admission of patients with a normal CT scan is not cost-effective,23 and as noted above, the risk of delayed bleeding is minimal. These patients should be discharged with good advice for the patient and/or carer.…”

Section: Case Review: Who Should I Scan?mentioning

confidence: 99%

“…Although MRI may be more sensitive to small lesions, it is more costly and time consuming 22. Not all patients with a head injury receive a CT scan: it is not necessary nor effective to scan everyone and it costs more than a selective scanning approach 23. CDRs have been developed to guide clinician decisions for who to scan and to rationalise the use of CT scanning in order to avoid unnecessary radiation exposure for patients and use healthcare resources judiciously, but few have been adequately validated 24.…”

Section: Evidence For Ct Scans Of the Head For Patients Taking Warfarinmentioning

confidence: 99%

Understanding the management of patients with head injury taking warfarin: who should we scan and when? Lessons from the AHEAD study

Mason

Evans²,

Kuczawski

2018

Emerg Med J

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Anticoagulated patients represent an important and increasing proportion of the patients with head trauma attending the ED, but there is no international consensus for their appropriate investigation and management. International guidelines vary and are largely based on a small number of studies, which provide poor-quality evidence for the management of patients taking warfarin. This article provides an overview of the clinical research evidence for CT scanning head-injured patients taking warfarin and a discussion of interpretation of risk and acceptable risk. We aim to provide shop floor clinicians with an understanding of the limitations of the evidence in this field and the limitations of applying 'one-size-fits-all' guidelines to individual patients. There is good evidence for a more selective scanning approach to patients with head injuries taking warfarin than is currently recommended by most guidelines. Specifically, patients without any head injury-related symptoms and GCS score 15 have a reduced risk of adverse outcome and may not need to be scanned. We argue that there is evidence to support an individualised approach to decision to CT scan in mild head injuries on warfarin and that clinicians should feel able to discuss risks with patients and sometimes decide not to scan.

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The cost-effectiveness of diagnostic management strategies for adults with minor head injury

Cited by 34 publications

References 22 publications

Evaluation of a revised in-hospital trauma activation protocol according to clinical outcome for patients with major trauma

Evaluation of a revised in-hospital trauma activation protocol according to clinical outcome for patients with major trauma

Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation

Understanding the management of patients with head injury taking warfarin: who should we scan and when? Lessons from the AHEAD study

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