The objective of this audit was to determine the appropriateness of CT head requests in trauma at a single-site Emergency Department in regional Queensland, using the Canadian CT Head Rule (CCHR) as the standard of reference.
Methods and materials
Approximately 150 in 100,000 Australians present to theEmergency Department (ED) with a closed head injury .Approximately 80% of these cases are categorised as minor .
For low-risk patients without obvious signs of brain injury, the needfor neuroimaging can often be avoided. However, this is not alwayspractised as CT imaging is becoming increasingly ubiquitous.
The Canadian CT Head Rule (CCHR) attempts to address thisissue. It is a well-validated tool used to identify those patientspresenting with a minor head injury that should undergo a CT scanonly...
A total of 172 patients were recruited in the study, and were stratified by age / gender / mode of arrival / mechanism of injury / GCS score. [Fig 3]
The CCHR was then retrospectively applied to these patients:
67 patients met one or more of the high risk criteria for neurosurgical intervention
21 patients met one or more of the medium risk criteria for clinically significant brain injury
This left a total of 84 patients that did not meet either of the high risk...
This audit demonstrates that the retrospective application of the Canadian CT Head Rule for patients presenting with a traumatic head injury would have reduced the number of CT head scans performed by 48.8%. This statistic has significant implications, especially for a resource-poor regional hospital with only several full-time radiologists.
Of the patients that could have avoided imaging as per the CCHR criteria had it been followed, 3 cases (3.6%) did have intracranial findings reported on CT:
A 37 year old female with small bifrontal cerebral...
Nothing to disclose
Harrison, J., Y. Helps, and G. Henley. "Hospital separations due to traumatic brain injury, Australia 2004-05." Injury research and statistics series 45 (2008).
Faux S, Sheedy J. A prospective controlled study in the prevalence of posttraumatic headache following mild traumatic brain injury. Pain Med. 2008; 9(8): 1001-11.
Stiell, Ian G., et al. "The Canadian CT Head Rule for patients with minor head injury." The Lancet 357.9266 (2001): 1391-1396.
Choosing Wisely Australia. "Radiology tests & treatments: 11 recommendations from the Royal Australian and New Zealand College...