Variation in ED Use of Computed Tomography for Patients With Minor Head Injury

Study objective: To determine the frequency of utilization, yield for brain injury, incidence of missed injury, and variation in the use of computed tomography (CT) for ED patients with minor head injury. Methods: This retrospective health records survey was conducted over a 12-month period in the E...

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Bibliographic Details
Published in:Annals of emergency medicine 1997-07, Vol.30 (1), p.14-22
Main Authors: Stiell, Ian G, Wells, George A, Vandemheen, Katherine, Laupacis, Andreas, Brison, Robert, Eisenhauer, Mary A, Greenberg, Gary H, MacPhail, Iain, McKnight, R.Douglas, Reardon, Mark, Verbeek, Richard, Worthington, James, Lesiuk, Howard
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Canada
Emergency Service, Hospital
Female
Head Injuries, Closed - diagnostic imaging
Hematoma, Subdural - diagnostic imaging
Humans
Investigative techniques, diagnostic techniques (general aspects)
Logistic Models
Male
Medical sciences
Middle Aged
Nervous system
Odds Ratio
Predictive Value of Tests
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Retrospective Studies
Tomography, X-Ray Computed - statistics & numerical data
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Summary:Study objective: To determine the frequency of utilization, yield for brain injury, incidence of missed injury, and variation in the use of computed tomography (CT) for ED patients with minor head injury. Methods: This retrospective health records survey was conducted over a 12-month period in the EDs at seven Canadian teaching institutions. Included in this review were adult patients who sustained acute minor head injury, defined as witnessed loss of consciousness or amnesia and a Glasgow Coma Scale score of 13 or greater. Data were collected by research assistants who were trained to select cases and abstract data in a standardized fashion according to a resource manual. Subsequently, patient eligibility was reviewed by the study coordinator and principal investigator. Results: Of the 1,699 patients seen, 521 (30.7%) were referred for CT, and 418 (79.8%) of these scans were negative for any type of brain injury. Overall, 105 (6.2%) of these patients sustained acute brain injury, including 9 (.5%) with an epidural hematoma. Cochran's Q test for homogeneity demonstrated significant variation between the seven centers for rate of ordering CT ( P
ISSN:0196-0644
1097-6760
DOI:10.1016/S0196-0644(97)70104-5