Mindless Scanning: Does Every Trauma Patient Need a Head CT?

Abstract

Head trauma is a common occurrence in trauma patients. Due to the significant morbidity and mortality from a missed intracranial bleed, many physicians feel pressured to order unindicated CT scans of the head. The objective of this study was to determine if an educational intervention can reduce unnecessary CTs of the head. Data were prospectively collected on 973 trauma patients evaluated between April 1, 2015 and October 1, 2016. Patients over the age of 15 who were evaluated by trauma surgery were included. They were divided into 2 groups: pre-intervention (n = 646) and post-intervention (n = 327). The intervention included educational sessions, laminated pocket cards, and a real-time electronic decision support tool. The criteria used to determine if imaging was indicated were a combination of the New Orleans and Canadian CT head rules. In the pre-intervention group, 131 patients received unindicated scans compared with 37 in the post-intervention group, which equated to a 72% reduction. Even with the difference in group size, this difference was statistically significant, with p < 0.001. An educational intervention with a real-time electronic decision support tool can reduce unindicated CT scans of the head and lead to more cost-effective patient care.