Overuse of computed tomography for mild head injury: A systematic review and meta-analysis

• Published in: PloS one 2024-01, Vol.19 (1), p.e0293558-e0293558
• Main Authors: Saran, Maryam, Arab-Zozani, Morteza, Behzadifar, Meysam, Gholami, Mehrdad, Azari, Samad, Bragazzi, Nicola Luigi, Behzadifar, Masoud
• Format: Article
• Language: English
• Subjects: Bias; Biology and Life Sciences; Brain research; Canada; Care and treatment; Child; Computed tomography; Craniocerebral Trauma - diagnostic imaging; Criteria; Cross-Sectional Studies; CT imaging; Data collection; Diagnosis; Emergency medical care; Emergency medical services; Estimates; Evaluation; Glasgow Coma Scale; Grey literature; Head; Head injuries; Health care; Health care expenditures; Heterogeneity; Humans; Imaging techniques; Information sources; Injuries; Injury analysis; Institutional repositories; Medical imaging; Medicine and Health Sciences; Meta-analysis; Observational studies; Patients; Pediatrics; Physical Sciences; Radiation; Radiation effects; Research and Analysis Methods; Sensitivity analysis; Social Sciences; Subgroups; Synthesis; Systematic review; Tomography; Tomography, X-Ray Computed
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0293558

Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury. Eligibility criteria: We encompassed observational studies-either designed as cohort, case-control, or cross-sectional investigations-that reported on CT scan overuse rates for mild head injuries. Studies had to be published in peer-reviewed, English-language sources and provide full content access Information sources: Web of Sciences, Scopus, Medline via PubMed, the Cochrane Library and Embase were searched from inception until April 1, 2023. Studies were included if reporting the overuse of CT scans for mild head injuries using validated criteria. Risk of bias: We used the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to evaluate the risk bias assessment of included studies. Two independent reviewers evaluated the eligibility of studies, extracted data, and assessed study quality by using the Newcastle-Ottawa Scale. Synthesis of results: Overuse estimates were calculated using a random-effects model. Subgroup analyses were performed to investigate any sources of heterogeneity. Point rate of overuse of CT scans for mild head injuries was the main outcome measured as percentage point estimates with corresponding 95% CIs. Included studies: Of the 913 potentially relevant studies identified, eight studies were selected for the final analysis. Synthesis of results: The pooled rate of CT scan overuse in patients with mild head injury was found to be 27% [95% CI: 16-43; I2 = 99%]. The rate of CT scan overuse in mild head injury cases varied depending on the criteria used. The rate of CT scan overuse was 37% [95% CI: 32-42; I2 = 0%] with the Glasgow Coma Scale (GCS), 30% [95% CI: 16-49; I2 = 99%] with the Canadian computed tomography head rule, and 10% [95% CI: 8-14; I2 = 0%] with the Pediatric Emergency Care Applied Research Network criterion (PERCAN). Based on subgroup analyses, the rate of CT scan overuse in mild head injury cases was observed to be 30% with the Canadian computed tomography head rule criterion, 43% with the National Institute for Health and Clinical Excellence criterion, and 18% with the New Orleans criterion. Limitations of evidence: The restricted number of included studies may impact generalizab