Congress:
EuroSafe Imaging 2020
Keywords:
Performed at one institution, Case-control study, Retrospective, Acute, Radiation safety, Education, CT, Radioprotection / Radiation dose, Head and neck, Emergency, Emergency Imaging
Authors:
G. clesceri, G. Lo Re, M. T. Anzelmo, M. C. Terranova, A. Crapanzano, S. Salerno, T. V. Bartolotta
DOI:
10.26044/esi2020/ESI-11297
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.
Results:
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%.