Rational use of Computed Tomography Scan head in the Emergency Department of a high volume tertiary care public sector hospital.

Tahira Nishtar,Fayaz Muhammad,Tabish Ahmad,Norliza Mohd Noor

doi:10.12669/pjms.35.2.719

Abstract

Objective:To emphasize the rational use of Computed Tomography (CT) head in emergency department (ED) of a high volume tertiary care hospital.Methods:This retrospective observational study was conducted in Radiology Department of Medical Teaching Institute Lady Reading Hospital (MTI-LRH), Peshawar, Pakistan from November 1st 2017 to 31st January 2018. Patients of all ages and both genders presenting to the emergency department with post traumatic and non-traumatic indications for emergency CT head scan were included in the study. The imaging was performed on GE 16 multi slice Optima CT system. The imaging protocol included slice thickness of 3-5mm, non-contrast study for cases of head trauma or suspected stroke. Where needed intravenous contrast was administered e.g. to exclude meningitis in patients presenting with severe headache. Patients undergoing CT examination for regions of the body other than head and brain were excluded from the study as their number was insignificant. Reporting was done on PACS and results analyzed using latest SPSS version.Results:Out of 4284 CT scans performed in emergency department 90.8% were CT head (3893). Among 3893 CT scan head done in ED, 2581 cases were reported normal (66.29%), while 1312 cases had positive findings (33.7%), including post traumatic and non-traumatic.Conclusion:Misuse of CT head is common especially in an emergency setting. Emergency physicians should be encouraged to obtain a detailed history and perform a thorough physical examination with reference to internationally standardized guidelines, while ordering CT scan.

Highlights

Computed Tomography (CT) scan is an important investigating tool in the emergency department (ED) in establishing a particular diagnosis or otherwise helping a physician to exclude one
The most common CT scan done in an emergency department is CT head, which falls under two categories i.e. post traumatic and non-traumatic CT head.[2]
Patients of all ages and both genders presenting to the emergency department with post traumatic and non-traumatic indications for CT head were included in the study

Summary

INTRODUCTION

CT scan is an important investigating tool in the ED in establishing a particular diagnosis or otherwise helping a physician to exclude one. There are certain pre-requisites for ordering a CT Scan of Head It includes comprehensive history & physical examination and documentation concerning relevant symptoms related to ordering a specific CT examination with reference to the standardized international guidelines for CT imaging in an emergency setting (Fig.1, 2 & 3). This is perhaps first study of its kind performed in a public sector hospital of the Pukhtunkhawa province of Pakistan. 19.98 13.72 33.7 finding of infarct rather than suspected bleed or vice versa were both considered as positive Those patients who had normal CT were considered as negative.

RESULTS

DISCUSSION

Findings

CONCLUSION