Unnecessary head computed tomography scans: a level 1 trauma teaching experience

Area of Science:

• Emergency Medicine
• Radiology
• Trauma Surgery

Background:

• The Canadian CT Head Rule aims to standardize head CT use in minor head injuries.
• Existing research suggests 10-35% of head CT scans do not meet established guidelines.
• This highlights a need to evaluate current practices in mild traumatic brain injury assessment.

Purpose of the Study:

• To review head CT scan utilization for mild traumatic brain injury.
• To identify unnecessary head CT scans (UHCT).
• To determine variables associated with UHCT and their associated costs.

Main Methods:

• A trauma registry was used to identify patients over 18 with a Glasgow Coma Scale of 15 and a head CT.
• Unnecessary head CT scans (UHCT) were defined as those without head injury, LOC, amnesia, or neurological complaint.
• Univariate analyses identified associated variables and costs.

Main Results:

• 24.2% of reviewed CT scans were classified as UHCT.
• Factors associated with UHCT included ages 41-64, drug use, vehicular injury, and recent surgery (P < 0.05).
• UHCTs correlated with higher Injury Severity Scores, increased ventilator days, and longer hospital stays, costing an additional $149,778.

Conclusions:

• Current practices at the Level I trauma center result in a significant proportion of unnecessary head CT scans.
• Implementing best practices for head CT utilization can reduce costs.
• Optimizing CT scan use improves patient care and resource allocation.