Appropriateness of out-of-hours CT head scans

This study was conducted to evaluate the appropriateness of the out-of-hours computed tomography (CT) head scans (scans performed outside normal working hours) in a large district general hospital in the United Kingdom. CT scan request forms and CT reports of adult patients were reviewed who had their CT head scans done between 1700 and 0900 h the next day and all weekend and national holidays in the study period of 4 months. Information regarding change in the patient management resulting from CT scan was extracted from review of patients' case notes. An urgent CT head scan request was deemed appropriate if it led to an immediate change in a patient's management. Appropriateness of the requests according to the various guidelines was also evaluated. One hundred and twenty-one patients were included in the study. Majority (70%) of the scans were requested by the emergency department. Eighty-one (66%) scans were both requested and performed between 1700 and 2200 h. Immediate change in management of 80% patients occurred. In 20 (17%), the change in management occurred only after 0900 h the next day and in 4 (3%), management did not change at all. Common scenarios involving change in patient's management included intracranial bleed requiring urgent neurosurgical intervention and hemorrhagic stroke being ruled out. Out-of-hours CT head scans also facilitated early discharge of the patients with head injuries and headache from the hospital. This retrospective study has found that a high proportion of out-of-hours CT head scans were appropriate and led to change in the patient's immediate medical care.