How frequently does head CT affect decision making in the emergency setting?

Abstract

Objective: To determine the overall frequency with which head computed tomography (HCT) affects decision-making in emergency department (ED) patients overall and on the basis of specific clinical findings and indications. Methods: Staff requesting HCT scans from the ED prospectively completed a form detailing patient complaints, selected history and physical findings, and likely disposition based upon clinical findings. After completion of the HCT, the clinician reported whether the HCT scan affected therapy and in what way. Results: Of a total 567 patient-visits from June 9, 1999 through September 7, 2000, HCT altered therapy 22 % of the time. The most frequent alterations in care as a result of the CT were: medications withheld or given, indwelling shunt adjustment, and alteration in stroke protocol. A significant number of patients in all risk categories had their care altered. There was a correlation between physicians' pre-HCT assessment of the likelihood that HCT would affect emergency care and the frequency that HCT did alter care. Conclusions: A high rate of unexpected therapy and disposition changes occurred on the basis of HCT in all risk categories of ED patients. History and physical data were good predictors of the utility of this study.