A multimodal intervention reduces computed tomography use in blunt head injury

Area of Science:

• Emergency Medicine
• Radiology
• Health Services Research

Background:

• Computed tomography (CT) is widely used in emergency departments (EDs) for blunt head injury, but overuse leads to increased costs and radiation exposure.
• Despite clinical decision rules, head CT utilization is rising, necessitating effective implementation strategies.

Purpose of the Study:

• To evaluate the effectiveness of a multi-modal intervention in reducing head CT utilization in the ED.
• To assess the impact of the intervention on the rates of positive CT scans and patient return visits.

Main Methods:

• A retrospective pre-post analysis was conducted across three EDs implementing a guideline, education, provider feedback, and EHR-integrated clinical decision support (CDS).
• The study included adult patients (18-64) without high-risk features, analyzing CT brain utilization and secondary outcomes using logistic regression and statistical process control charts.

Main Results:

• The intervention significantly reduced the odds of CT brain studies by 9% for all encounters and 8% for traumatic chief complaints.
• Statistical process control charts indicated sustained reduction in CT utilization post-intervention.
• No significant differences were observed in the rates of positive head CTs, 72-h ED return visits, or 72-h returns with positive radiographic TBI.

Conclusions:

• An institutional guideline, supported by education, feedback, and CDS, effectively reduced head CT utilization in emergency departments.
• This approach offers a viable strategy for optimizing CT use in blunt head injury evaluations.