EuroSafe Imaging 2020
Performed at one institution, Case-control study, Retrospective, Acute, Radiation safety, Education, CT, Radioprotection / Radiation dose, Head and neck, Emergency, Emergency Imaging
G. clesceri, G. Lo Re, M. T. Anzelmo, M. C. Terranova, A. Crapanzano, S. Salerno, T. V. Bartolotta
Description of activity and work performed
Materials and methods:
We retrospectively evaluated 493 CT scans of patients aged 18–45 years, collecting the following parameters from ED medical records: patient demographics, risk factors indicating the need of brain imaging, trauma mechanism, specialty and seniority of the referring physician. For each CT, the effective dose and the negativity/positivity were assessed.
357/493 (72%) and 347/493 (70%) examinations were not in line with the CCHR and NICE guidelines, respectively.
No statistically significant difference between physician specialty (p = 0.29 for CCHR; p = 0.24 for NICE), nor between physician seniority and the amount of inappropriate examinations (p = 0.93 for CCHR, p = 0.97 for NICE) was found but CT scans requested by ED physicians were less inappropriate [p = 0.28, odds ratio (OR) 0.562, CI (95%) 0.336–0.939]. There was no statistically significant correlation between patient age and over-referral (p = 0.74 for NICE, p = 0.93 for CCHR). According to NICE, low speed motor vehicle accident (p = 0.009) and domestic injuries (p = 0.002) were associated with a higher rate of unwarranted CT; according to CCHR only low speed motor vehicle accident showed a significant correlation with unwarranted CT scan (p < 0.001, OR 44.650, CI 33.123–1469.854).
2% of CT was positive.
Multivariate analysis demonstrated that factors significantly associated with CT scan positivity included signs of suspected skull fracture (p < 0.001, OR 20.430, CI 2.727–153.052) and motor vehicle accident with high energy impact (p < 0.001, OR 220.650, CI 33.123–1469.854).
In our series, CCHR showed sensitivity of 100%, specificity of 74%; NICE showed sensitivity of 100%, specificity of 72%.