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A Quality Improvement Campaign Reduces Head and Cervical Spine Imaging in Low-risk Trauma Patients
Jude C Luke1, Rebecca N Kubick1, Heidi J Sucharew2
1University of Cincinnati College of Medicine, Cincinnati, Ohio.
Introduction:
While computed tomography (CT) is invaluable for detecting life-threatening injuries in the emergency department (ED), the literature shows increasing use of head CT and cervical spine CT in low-risk trauma patients without a corresponding rise in injuries identified. These low-yield exams expose patients to avoidable radiation, increase costs, and contribute to inefficiencies in already overburdened EDs. In this study we evaluated the impact of a multimodal quality improvement (QI) campaign to reduce the use of head and cervical spine CT in low-risk trauma patients.
Methods:
This prospective QI intervention involved two EDs within one healthcare network: an academic trauma center and a community hospital. We collected data on baseline CT use for six months, followed by a 23-month intervention period. Primary outcomes were monthly rates of low-risk trauma head and cervical spine CT per 100 ED patients; secondary outcome was the rate of all-cause CT use per 100 ED patients. We plotted rates over time using u-charts with mean-shift lines. Pre- and post-shift differences were summarized as rate ratios (RR) with 95% confidence intervals, compared using the Poisson test.
Results:
Use of head CT for low-risk trauma decreased from 5.00 to 4.01 per 100 patients at the academic site (RR = 0.80, 95% CI, 0.75-0.86, P < .001) and from 6.64 to 5.12 per 100 patients at the community site (RR 0.77, 95% CI, 0.73-0.82, P < .001). Use of cervical spine CT for low-risk trauma decreased from 3.36 to 2.83 per 100 patients at the academic site (RR = 0.84, 95% CI, 0.78-0.91, P < .001) and from 4.31 to 3.49 at the community site (RR = 0.81, 95% CI, 0.75-0.87, P < .001). All-cause CT use decreased at the academic site from 53.06 to 47.91 CT exams per 100 patients [RR = 0.90, 95% CI, 0.89-0.92, P < .001] but remained unchanged at the community site.
Conclusion:
A structured quality improvement campaign led to a significant reduction in the use of head and cervical spine CT in low-risk trauma patients. These findings provide a framework for promoting evidence-based imaging practice.
