Head injuries represent a significant number of presentations to the emergency department (ED) each year.TheCanadian CT Head rule(CCTHR)is a clinical decision making tool aimed atstandardisingthe emergency management of patients with head injury[1]. The threeprimary objectives of this audit were to: 1) Evaluate patients receiving CT head scans in the ED and determinethe rate of compliancewith the CCTHR. 2) Correlation with CCTHR compliance/noncompliance with various clinical outcomes. 3) Identify factors contributing to non-compliance with the CCTHR, with specific reference to alcohol intoxication on presentation.

Ethics approval sought from GCHHS HREC - HREC/16/QGC/198 Methods: Using a list generated by the imaging system (IMPACS), a retrospective clinical audit was conducted of all requests for CT head scans ordered by the GCUH ED during the month of June 2016. Of the total 461 requests, 283 had no previous history of blunt head trauma and were excluded from this study. More specifically, 103 studies were performed querying cerebrovascular accident, 37 querying cause of seizure, 70 querying cause for altered level of consciousness and...

Compliance with CCTHR in eligible patients: Only 54 out of the 158 patients receiving CT head scans satisfied both inclusion and exclusion critieriafor application of the CCTHR. Of these patients receiving scans, 74.1% were indicated according to the CCTHR. 25.9% were not indicated due to an absence of high or medium risk factors. Correlation with CCTHR compliance/noncompliance and various outcomes: 17.5% of patients who received CT headscans in accordance with the CCTHR were found to haveclinically significant brain injury requiring hospital admission. All of these...

In the emergency department setting, CT head scans are often over-utilised. Its routine use in the evaluation of head trauma without abidance to a clinical decision-making tool results in low diagnostic yield.In previous validation trials, sensitivity of the CCTHR has been found to be 100% [6].This local study found that compliance with the CCTHR in eligible patientswas fairly high, at74.1%. However, ED clinicians are more likely to inappropriately request CT head scans in the setting of intoxication despite the absence of any medium or high-risk...

1.Australasian College for Emergency Medicine [homepage on the internet].Melbourne: Australasian College for Emergency Medicine; [updated 2012 July]. Guidelines on Diagnostic Imaging. Available from: https://acem.org.au/getattachment/17ee11f1-bdaf-4ca4-a524-396690123ba7/Diagnostic-Imaging.aspx 2. Diagnostic Imaging Pathways [homepage on the internet]. Western Australia: Diagnostic Imaging Pathways; [Updated 2013 August]. Cerebrovascular Blunt Injury. Available from: http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/musculoskeletal-trauma/trauma/blunt-cerebrovascular-injury#pathway-home 3. Steill I, Wells G, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury.The Lancet2001; 357(9266): 1391-1396. 4. Smits M, Dippel DW, de Haan GG, et al. External validation of the Canadian CT...