Cheuk Kei Kathy Wong MBBS, FRCR, Presenter: Nothing to Disclose

W.L. William Poon, Abstract Co-Author: Nothing to Disclose

On Cheung Leung, Abstract Co-Author: Nothing to Disclose

Samuel Chan, Abstract Co-Author: Nothing to Disclose

Victoria To, Abstract Co-Author: Nothing to Disclose

Susie Wong, Abstract Co-Author: Nothing to Disclose

Po Chung Lau MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

In the AED, investigations guide clinical management but may imply extra resources, time and stress to the staffs and patients. Head injury is one of the commonest indications for performing urgent CT head in AED. We wish to know whether NICE guideline is accurate or not in identifying patients with head injuries requiring urgent CT head in AED

All urgent CT head requests from the AED in Feb and Mar 2010 were retrospectively reviewed. CT performed for known or suspected head injuries were included. Other indications and cases without enough data on AED record were excluded. Information on AED records and CT request forms were extracted according to the NICE guideline. The CT requests were classified as “indicated” if they followed the NICE guideline, and as “not indicated” if they did not do so. Pathology found in CT which was directly related to head injuries, number of patients requiring neurosurgical intervention and clinical outcome of all included patients were recorded. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the NICE guideline were calculated.

953 urgent CT head performed for AED from Feb to Mar 2010. 393 were performed for head injury, excluding 22 due to insufficient information or other indications. 371 patients with urgent CT heads for head injuries were included, ranged from 0.5 to 101 year-old (M:F 181:190, average 56 year old). 119 CT were indicated (NICE positive), 252 were not (NICE negative). 39 CT had positive findings related to head injury, in which 27 were NICE positive (sensitivity: 69%, specificity: 72%, positive and negative predictive value PPV, NPV: 23%, 95%). 8 required neurosurgical interventions, all were NICE positive (sensitivity: 100%, specificity: 69%, PPV, NPV: 7%, 100%). None of the 12 NICE missed cases required neurosurgical intervention, only conservative management and follow-up imaging.  

The use of NICE guideline in the AED for assessing patients with head injury is helpful and safe in identifying head injury patients requiring neurosurgical intervention. Adherence to the NICE guideline reduces tremendous cost and resources and radiation exposure to head injured patients. 

Adhere to NICE would have saved 252 CT head for head injuries over the 2-months audit period and 1 patient from developing cancer attributable to unnecessary CT head in his/her lifetime every 5.8years

Wong, C, Poon, W, Leung, O, Chan, S, To, V, Wong, S, Lau, P, Usefulness of NICE Guideline in Refining Indication for Urgent CT Head Injury Imaging in the Accident and Emergency Department (AED).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011300.html