Is routine computed tomography scanning too expensive for mild head injury?

Area of Science:

• Emergency Medicine
• Neurosurgery
• Health Economics

Background:

• Mild head injuries require careful management to balance patient safety and healthcare costs.
• Diagnostic imaging plays a crucial role in assessing intracranial injuries.
• Previous cost analyses have not definitively established the most cost-effective diagnostic pathway for all mildly head-injured patients.

Purpose of the Study:

• To compare the relative costs of treating mildly head-injured patients using different diagnostic and admission protocols.
• To evaluate the cost-effectiveness of routine admission, skull radiography screening, and cranial computed tomography (CT) scanning for mildly head-injured patients.

Main Methods:

• Retrospective record review of 658 consecutive mildly head-injured patients admitted between 1986 and 1988.
• Hypothetical costs were calculated based on actual patient courses, including length of hospitalization and surgical interventions.
• Comparison of costs across different treatment protocols: routine admission, skull radiography screening, and CT scanning.

Main Results:

• Routine admission with skull radiographs and selective CT scans cost an average of $1,207 per patient.
• Using CT scans to identify intracranial lesions and discharging others resulted in nearly 10% cost savings.
• Skull radiography screening was projected to be 22% cheaper than routine CT but risked increased costs due to missed injuries.

Conclusions:

• Routine cranial computed tomography (CT) scanning is recommended for all patients with loss of consciousness or post-traumatic amnesia.
• Patients with normal CT scans and no other admission indications can be safely discharged from the emergency department.
• This approach offers optimal medical care and is cost-effective.