Computed tomography scans of the head for adult patients with minor head injury: are clinical decision rules a necessary evil?
This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability in the local adult population with minor head injury. We conducted a retrospective study of consecutive patients who presented to the adult emergency department (E...
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Published in | Singapore medical journal |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Singapore
25.05.2017
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Abstract | This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability in the local adult population with minor head injury.
We conducted a retrospective study of consecutive patients who presented to the adult emergency department (ED) with minor head injury over six months. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR assessed by comparing the recommendations for head computed tomography (CT) scans to its actual usage.
In total, 349 patients satisfied the inclusion criteria. Common mechanisms of injury were falls (59.3%), motor vehicle crashes (16.9%) and assault (12.0%). There were 249 (71.3%) patients who underwent head CT, yielding 42 (12.0%) clinically significant findings. 1 (0.3%) patient required neurosurgical intervention. Head CT was recommended according to CCHR for 209 (59.9%) patients. Compliance with the CCHR was 71.3%. Among the noncompliant group, head CT was overperformed for 20.1% and underperformed for 8.6% of patients. Multivariate logistic regression analysis revealed the absence of retrograde amnesia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.8-9.7) to be associated with noncompliance to the CCHR. Factors associated with underperformance were absence of motor vehicle crashes as a mechanism of injury (OR 6.6, 95% CI 1.2-36.3) and absence of headache (OR 10.8, 95% CI 1.3-87.4).
Compliance with the CCHR for adult patients with minor head injury remains low in the ED. A qualitative review of physicians' practices and patients' preferences may be carried out to evaluate reasons for noncompliance. |
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AbstractList | This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability in the local adult population with minor head injury.
We conducted a retrospective study of consecutive patients who presented to the adult emergency department (ED) with minor head injury over six months. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR assessed by comparing the recommendations for head computed tomography (CT) scans to its actual usage.
In total, 349 patients satisfied the inclusion criteria. Common mechanisms of injury were falls (59.3%), motor vehicle crashes (16.9%) and assault (12.0%). There were 249 (71.3%) patients who underwent head CT, yielding 42 (12.0%) clinically significant findings. 1 (0.3%) patient required neurosurgical intervention. Head CT was recommended according to CCHR for 209 (59.9%) patients. Compliance with the CCHR was 71.3%. Among the noncompliant group, head CT was overperformed for 20.1% and underperformed for 8.6% of patients. Multivariate logistic regression analysis revealed the absence of retrograde amnesia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.8-9.7) to be associated with noncompliance to the CCHR. Factors associated with underperformance were absence of motor vehicle crashes as a mechanism of injury (OR 6.6, 95% CI 1.2-36.3) and absence of headache (OR 10.8, 95% CI 1.3-87.4).
Compliance with the CCHR for adult patients with minor head injury remains low in the ED. A qualitative review of physicians' practices and patients' preferences may be carried out to evaluate reasons for noncompliance. |
Author | Ibrahim, Irwani Chan, Yiong Huak Peng, Li Lee Kuan, Win Sen Tan, Desmond Wei Lim, Annabelle Mei En Ong, Daniel Yuxuan |
Author_xml | – sequence: 1 givenname: Desmond Wei surname: Tan fullname: Tan, Desmond Wei organization: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 2 givenname: Annabelle Mei En surname: Lim fullname: Lim, Annabelle Mei En organization: Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 3 givenname: Daniel Yuxuan surname: Ong fullname: Ong, Daniel Yuxuan organization: Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 4 givenname: Li Lee surname: Peng fullname: Peng, Li Lee organization: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 5 givenname: Yiong Huak surname: Chan fullname: Chan, Yiong Huak organization: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 6 givenname: Irwani surname: Ibrahim fullname: Ibrahim, Irwani organization: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 7 givenname: Win Sen surname: Kuan fullname: Kuan, Win Sen organization: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore |
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