CT for Minor Head Injury in Adults
Minor head injury is a common reason for patients visiting the emergency department. Most patients to do not have a cause leading to a severe injury such as bleeding in the brain or skull fracture that would require use of a CT scan to diagnose. There are excellent evidence-based guidelines to determine which type of patients need a CT scan based on a careful taking of the medical history and physical examination, but the majority will not. As CT scans expose patients to ionizing radiation, they should only be used on patients at risk. This approach is a Choosing Wisely recommendation and has been endorsed by the American College of Emergency Physicians in conjunction with the Centers for Disease Control and Prevention, which have published guidelines recommending adherence to clinical decision rules when determining if a patient requires head CT imaging for these presentations. Within the Michigan Emergency Department Improvement Collaborative, we measure clinical performance against the standard of the Canadian CT Head Rule, which has consistently performed well in multiple settings and contexts.
Reduction of CT use in children with Minor Traumatic Head Injury:
Minor head injuries are a frequent cause for emergency department visitation by children and CT scans are often used unnecessarily as a diagnostic tool to exclude serious intracranial injuries. However, the use of CT scanning exposes children to dangerous radiation, increases risk due to requirements for sedation medication in young children and adds unnecessary expense when children have very low risk for serious intracranial injury. Strong medical evidence now endorsed by the American Academy of Pediatrics, American College of Emergency Physicians and the national Choosing Wisely campaign is now available that offers detailed guidance to emergency physicians’ decision making to better direct use of CT scans in children with head injuries. Physician members of MEDIC are now able to easily access their personal and institutional rates of CT scanning in children meeting criteria for minor head injury through the MEDIC data platform. They can also directly review cases for which CT scans were done to review patient records to monitor their own performance. The MEDIC collaborative has adopted both collaborative wide as well as institutional targets for reduction in overuse of CT scanning for children with minor traumatic brain injury who meet select criteria.