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Lauren Dubinsky, Senior Reporter | February 28, 2018
Not in line with current
medical criteria
Emergency head CT exams to check for skull fractures and brain hemorrhage may be overused, according to a new study conducted by the Fatebenefratelli-Sacco Hospital in Italy.
These findings will be presented at the American Roentgen Ray Society 2018 Annual Meeting in Washington, DC at the end of April.
The researchers assessed head CT scans performed for minor head injury to determine if the referral met the National Institute for Health and Care Excellence (NICE) and the Canadian CT Head Rule (CCHR) criteria. The patients were between the ages of 18 and 45 and presented to the hospital’s ED from January 1 to June 30, 2016.
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Out of the 492 CT exams that were reviewed, nearly 53 percent (260) and 76.4 percent (374) of them were not in line with NICE and CCHR criteria, respectively. Only 15 of the 260 CT exams were positive for brain hemorrhage, subarachnoid hemorrhage, or skull fracture.
The research team found that the specialty and seniority of the referring physician had no effect on the rate of unnecessary exams. The patient’s age also had no impact on the unwarranted CT exams.
Motor vehicle accidents were associated with a higher rate of non-indicated CT exams for NICE and CCHR criteria. On the other hand, two-wheel vehicle accidents had a higher rate of appropriate CT exams for both criteria.
This is not the first time CT exams have been deemed unnecessary.
A study conducted by a team at the University of Maryland School of Medicine found that CT pulmonary angiography is overused in the emergency department, compared to less risky tests.
They also found that CT is unnecessarily used evaluate respiratory symptoms and diagnose pulmonary embolism. These exams did not lead to improvements in outcomes and oftentimes resulted in false positive results.
“The downside of CT is primarily that one sees minor abnormalities that prompt a cascade of tests or even procedures, which are sometimes harmful, to investigate [as] false positive results,” Dr. Daniel Morgan of the University of Maryland School of Medicine, told HCB News at the time.
