Keywords:
Cost-effectiveness, Audit and standards, CT, Trauma, Neuroradiology brain, Emergency, Haemorrhage
Authors:
A. Parasuramar; SA/AU
DOI:
10.1594/ranzcr2018/R-0079
Results
71 patients were female (42%),
98 were male (58%).
Age range was 15 to 97,
average age was 71.
89 CT Heads were ordered for traumatic head injuries (53%) and 80 for non-traumatic indications (47%).
Refer to Table 1 for the distribution of different clinical indications for CT heads after-hours.
43 (26%) patients did not have a neurological exam performed or recorded.
Of the 126 patients who had neurological examinations,
21 had focal neurological deficits and 5 of these had acute pathology - Refer to Table 2.
40 Patients did not have a Glasgow Coma Score (GCS) recorded (2 had intracranial pathology),
103 were GCS 14-15 (9 had pathology),
19 were GCS 9-13 (3 had pathology),
12 were GCS 3-9 (none had pathology) - Refer to Table 3.
60 patients (36%) were discharged after scan,
38 (23%) were admitted to a medical team after the scan,
14 (8%) were patients who were already admitted,
5 were admitted to overnight-stay after the scan (3%),
and 7 were admitted to a surgical team after the scan (4%).
5 were transferred to the Royal Adelaide Hospital after the scan for neurosurgical or stroke services (3%).
Refer to Table 5 for more details regarding the timing of clinical decision making following the CT scan.
QEH had a diagnostic yield of 8% (14 patients) from all after-hours scans,
7 from traumatic presentations (4% of total) and 7 from non-traumatic.
4 patients had Subdural haematomas (SDH) (2.3%),
2 had subarachnoid haemorrhages (SAH) (1.2%),
2 had cerebral infarctions,
2 had intraparenchymal haemorrhages (IH),
2 had space-occupying-lesions (SOL),
1 had both an IH and a SOL and 1 had an IH and a SDH - Refer to Table 4.
When applying the CCHR to traumatic head injuries: scans were indicated in 38 patients (43%),
5 of which had intracranial pathology on head CT.
7 scans were not indicated (8%),
where none of which had intracranial pathology.
27 were performed as per the clinician’s judgment,
none of these patients had intracranial pathology.
14 patients were excluded due to having high risk factors - Refer to Table 6.
Figure 1 depicts the algorithm that should be used when applying the CCHR.