Skip to main content
SpringerLink
Log in

Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent.

Aim

To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years.

Methods

We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations.

Results

The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = −0.88, p = 0.0001), the proportion of important findings on cranial CT (r = −0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = −0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062).

Conclusions

The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Eng J Med. 2007;357(22):2277–84.

    Article  CAS  Google Scholar 

  2. Coco AS, O’Gurek DT. Increased emergency department computed tomography use for common chest symptoms without clear patient benefits. J Am Board Fam Med. 2012;25(1):33–41.

    Article  PubMed  Google Scholar 

  3. Hess EP, Haas LR, Shah ND, Stroebel RJ, Denham CR, Swensen SJ. Trends in computed tomography utilization rates: a longitudinal practice-based study. J Patient Saf. 2014;10(1):52–8.

    Article  PubMed  Google Scholar 

  4. Lee J, Evans CS, Singh N, et al. Head computed tomography utilization and intracranial hemorrhage rates. Emerg Radiol. 2012;20(3):219–23.

    Article  PubMed  Google Scholar 

  5. Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency department computed tomography utilization in the united states and canada. Ann Emerg Med. 2013;62(5):486–494.e3.

    Article  PubMed  Google Scholar 

  6. Fung Kon Jin PHP, Dijkgraaf MGW, Alons CL, et al. Improving CT scan capabilities with a new trauma workflow concept: Simulation of hospital logistics using different CT scanner scenarios. Eur J Radiol. 2011;80(2):504–9.

    Article  CAS  PubMed  Google Scholar 

  7. Körner M, Geyer LL, Wirth S, Reiser MF, Linsenmaier U. 64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow. AJR Am J Roentgenol. 2011;197(3):W399–404.

    Article  PubMed  Google Scholar 

  8. Glaser C, Trumm C, Nissen-Meyer S, Francke M, Küttner B, Reiser M. Spracherkennung: Auswirkung auf Workflow und Befundverfügbarkeit. Radiologe. 2005;45(8):735–42.

    Article  CAS  PubMed  Google Scholar 

  9. Kirsch TD, Hsieh Y‑H, Horana L, Holtzclaw SG, Silverman M, Chanmugam A. Computed tomography scan utilization in emergency departments: a multi-state analysis. J Emerg Med. 2011;41(3):302–9.

    Article  PubMed  Google Scholar 

  10. Müller K, Townend W, Biasca N, et al. S100B serum level predicts computed tomography findings after minor head injury. J Trauma. 2007;62(6):1452–6.

    Article  PubMed  Google Scholar 

  11. Studdert DM, Mello MM, Sage WM, et al. Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. JAMA. 2005;293(21):2609–17.

    Article  CAS  PubMed  Google Scholar 

  12. Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National Trends in Use of Computed Tomography in the Emergency Department. Ann Emerg Med. 2011;58(5):452–462.e3.

    Article  PubMed  Google Scholar 

  13. Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf. 2012;38(11):483–9.

    Article  PubMed  Google Scholar 

  14. Head injury | Guidance and guidelines | NICE. http://www.nice.org.uk/guidance/cg176. Accessed 05 Nov 2015.

  15. Bautista AB, Burgos A, Nickel BJ, Yoon JJ, Tilara AA, Amorosa JK. Do clinicians use the american college of radiology appropriateness criteria in the management of their patients? AJR Am J Roentgenol. 2009;192(6):1581–5.

    Article  PubMed  Google Scholar 

  16. Ahn S, Kim WY, Lim KS, et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLOS ONE. 2014;9(11):e112650.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Menoch MJA, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics. 2012;129(3):e690–7.

    Article  PubMed  Google Scholar 

  18. Stiell IG, Wells GA, Vandemheen K, et al. The canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.

    Article  CAS  PubMed  Google Scholar 

  19. Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK. Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. Australas Med J. 2015;8(7):235–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pinto A, Brunese L. Spectrum of diagnostic errors in radiology. World J Radiol. 2010;2(10):377–83.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Levine Z. Mild traumatic brain injury. Can Fam Physician. 2010;56(4):346–9.

    PubMed  PubMed Central  Google Scholar 

  22. Wolf H, Machold W, Frantal S, et al. Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the canadian CT head rule. J Neurosurg. 2014;120(2):447–52.

    Article  PubMed  Google Scholar 

  23. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5.

    Article  CAS  PubMed  Google Scholar 

  24. Gittleman AM, Ortiz AO, Keating DP, Katz DS. Indications for CT in patients receiving anticoagulation after head trauma. Am J Neuroradiol. 2005;26(3):603–6.

    PubMed  Google Scholar 

  25. Hermer LD, Brody H. Defensive Medicine, Cost Containment, and Reform. J Gen Intern Med. 2010;25(5):470–3.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Raja AS, Ip IK, Sodickson AD, et al. Radiology utilization in the emergency department: trends of the past 2 decades. AJR Am J Roentgenol. 2014;203(2):355–60.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by the First Faculty of Medicine, Charles University in Prague (PRVOUK – P27/LF1/1, PRVOUK-P03/LF1/9) and the Ministry of Health No. RVO VFN 64 165.

Author information

Authors and Affiliations

  1. Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 12808, Prague, Czech Republic

    Lukas Lambert M.D. M.S.C.S. Ph.D., Rohan Banerjee & Jan Danes

  2. Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

    Ondrej Foltan & Jan Briza

  3. Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

    Alena Lambertova & Pavel Harsa

Authors
  1. Lukas Lambert M.D. M.S.C.S. Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ondrej Foltan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Briza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alena Lambertova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pavel Harsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rohan Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Danes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lukas Lambert M.D. M.S.C.S. Ph.D..

Ethics declarations

Conflict of interest

L. Lambert, O. Foltan, J. Briza, A. Lambertova, P. Harsa, R. Banerjee and J. Danes declare that they have no competing interests.

Ethical standards

This retrospective study was performed in accordance with the Helsinki Declaration and informed consent was waived by the Institutional Review Board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lambert, L., Foltan, O., Briza, J. et al. Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need. Wien Klin Wochenschr 129, 159–163 (2017). https://doi.org/10.1007/s00508-016-1025-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-016-1025-6

Keywords

Search

Navigation