Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury

• Published in: Injury Vol. 45; no. 9; pp. 1503 - 1508
• Main Authors: Quaas, Joshua, Derrick, Bruce, Mitrani, Lindsey, Baarbe, Simon, Yarusi, Brett, Wiener, Dan, Newman, David
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2014
• Subjects: CAT scan (computed tomography); Craniocerebral Trauma - diagnostic imaging; Decision Making; Decision Support Techniques; Glasgow Coma Scale; Humans; Intracranial Hemorrhages - diagnostic imaging; Minor head injury; Orthopedics; Patient Preference - statistics & numerical data; Physicians - statistics & numerical data; Prospective Studies; Radiographic utilization; Risk Assessment; Risk Factors; Shared decision-making; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - utilization; United States; Minor head injury; Radiographic utilization; CAT scan (computed tomography); Risk assessment; Shared decision-making
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2014.05.012

Abstract Objective Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization. Methods This is a convenience sample survey study of adult minor head injury patients (GCS 15) and their physicians regarding factors influencing the decision to use CT to evaluate for intra-cranial haemorrhage. Once a head CT was ordered and before the results were known, both the patient and physician were given a one-page survey asking questions about their concern for injury and rationale for CT use. CT results and surveys were then recorded in a centralized database and analyzed. Results 584 subjects were enrolled over the 27-month study period. The rate of any intra-cranial haemorrhage was 3.3%. Both the physicians (6% pre-test estimate) and the patients (22% pre-test estimate) over-estimated risk for haemorrhage. Clinical decision rules were not met in 46% of cases where CT was used. Physicians listed an average of 5 factors from a list of 9 that influenced their decision to order CT. Patients listed an average of 1.7 factors influencing their decision to present to the Emergency Department for evaluation. Many patients felt cost (45%) and low risk stratification (34%) should weigh heavily in the decision to use CT. If asked to limit CT utilization, physicians were able to identify a group with less than 2% risk of injury. Conclusions Patients with low risk of intra-cranial injury continue to be evaluated by CT. Physician decision-making around the use of CT to evaluate minor head injury is multi-factorial. Shared decision-making between the patient and the physician in a low risk minor head injury encounter shows promise as a method to reduce CT utilization in this low risk cohort.