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

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Abstract

Aim

To assess the amount of computed tomography (CT) scans for minor head injury (MHI) performed in young patients in our emergency department (ED), not indicated by National Institute for Health and Clinical Excellence (NICE) and Canadian Computed Tomography Head Rules (CCHR), and to analyze factors contributing to unnecessary examinations. Secondary objectives were to calculate the effective dose, to establish the number of positive CT and to analyze which of the risk factors are correlated with positivity at CT; finally, to calculate sensitivity and specificity of NICE and CCHR in our population.

Materials and methods

We retrospectively evaluated 493 CT scans of patients aged 18–45 years, collecting the following parameters from ED medical records: patient demographics, risk factors indicating the need of brain imaging, trauma mechanism, specialty and seniority of the referring physician. For each CT, the effective dose and the negativity/positivity were assessed.

Results

357/493 (72%) and 347/493 (70%) examinations were not in line with the CCHR and NICE guidelines, respectively. No statistically significant difference between physician specialty (p = 0.29 for CCHR; p = 0.24 for NICE), nor between physician seniority and the amount of inappropriate examinations (p = 0.93 for CCHR, p = 0.97 for NICE) was found but CT scans requested by ED physicians were less inappropriate [p = 0.28, odds ratio (OR) 0.562, CI (95%) 0.336–0.939]. There was no statistically significant correlation between patient age and over-referral (p = 0.74 for NICE, p = 0.93 for CCHR). According to NICE, low speed motor vehicle accident (p = 0.009), motor vehicle accident with high energy impact (p < 0.01) and domestic injuries (p = 0.002) were associated with a higher rate of unwarranted CT; according to CCHR only motor vehicle accident with high energy impact showed a significant correlation with unwarranted CT scan (p < 0.001, OR 44.650, CI 33.123–1469.854). 2% of CT was positive. Multivariate analysis demonstrated that factors significantly associated with CT scan positivity included signs of suspected skull fracture (p < 0.001, OR 20.430, CI 2.727–153.052) and motor vehicle accident with high energy impact (p < 0.001, OR 220.650, CI 33.123–1469.854). In our series, CCHR showed sensitivity of 100%, specificity of 74%; NICE showed sensitivity of 100%, specificity of 72%.

Conclusion

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.

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Funding

No funding has been received for this study.

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Authors and Affiliations

  1. ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy

    Michaela Cellina, Chiara Floridi, Giulio Clesceri & Giancarlo Oliva

  2. IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy

    Marta Panzeri & Carlo Maria Andrea Martinenghi

Authors
  1. Michaela Cellina
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  2. Marta Panzeri
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  3. Chiara Floridi
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  4. Carlo Maria Andrea Martinenghi
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  5. Giulio Clesceri
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  6. Giancarlo Oliva
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Correspondence to Michaela Cellina.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval was granted for this retrospective study with a waiver of the requirement to obtain written informed consent from each patient.

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Cellina, M., Panzeri, M., Floridi, C. et al. Overuse of computed tomography for minor head injury in young patients: an analysis of promoting factors. Radiol med 123, 507–514 (2018). https://doi.org/10.1007/s11547-018-0871-x

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  • DOI: https://doi.org/10.1007/s11547-018-0871-x

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