Keywords:
Emergency, CT, Audit and standards, Decision analysis, Outcomes analysis, Acute, Trauma
Authors:
Z. Vajuhudeen; Mackay, QLD/AU
DOI:
10.26044/ranzcr2021/R-0430
Conclusion
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 contusions following a motor vehicle accident, and was discharged after a period of observation in the Short Stay Unit
- A 64 year old male with small-volume subdural and subarachnoid haemorrhage following a fall, and was admitted for a period of observation before being discharged
- A 64 year old male with small-volume subdural haemorrhage following a motor vehicle accident, and was admitted for a period of observation before being discharged
None of these patients had any documented neurological sequelae and were stable throughout their period of observation. The argument could therefore be made, albeit in retrospect, that these patients did not require CT imaging as their radiological injuries were deemed to be clinically insignificant.
It is anticipated that a repeat audit following an educational intervention amongst clinical staff in the Emergency Department would result in a reduction in the number of CT scans performed over the same timeframe.