Melissa W. Jung MD, Presenter: Nothing to Disclose

Mark Kim Kelly MD, Abstract Co-Author: Nothing to Disclose

Brent Griffith MD, Abstract Co-Author: Nothing to Disclose

Ananth Vishwanath Narayan MD, Abstract Co-Author: Nothing to Disclose

Seth Krupp MD, Abstract Co-Author: Nothing to Disclose

Phyllis Vallee MD, Abstract Co-Author: Nothing to Disclose

Jumana Nagarwalla MD, Abstract Co-Author: Nothing to Disclose

Patrick Loeckner MD, Abstract Co-Author: Nothing to Disclose

Rajan Jain MD, Abstract Co-Author: Research support, General Electric Company

Several guidelines for the emergent radiographic CT evaluation of head trauma exist, the ACEP Guidelines are the closest to a standard of care for emergency providers to follow. Phase 1 of our study prospectively evaluted head CT utilization in the setting of minor blunt head injury to determine if these guidelines are followed. Phase 2 prospectively evalutes head CT utilization after a focused educational lecture on the ACEP guidelines and Phase 1 results to determine the effect of education on clinical practice.

Patients were eligible if they had blunt head injury and a head CT. Presenting symptoms were analyzed to determine if patients met ACEP guidelines. After the first phase of enrollment an educational presentation was given to emergency providers focused on over utilization and proper application of the ACEP guidelines. We are currently enrolling patients in Phase 2 to determine if a directed educational intervention can decrease over utilization. TBI was defined as intracranial hemorrhage, contusion, diffuse axonal injury, infarct or skull fracture.Overutilization was defined as any study which did not meet ACEP guidelines.

In Phase 1, 758 patients were enrolled:447 men and 311 women. 18 patients had TBI on CT (2.5%), 12 (1.6%) had indeterminate findings and the remaining 728 (95.9%) were negative. Mechanisms of injury were fall (42%), MVA (22.6%), assault (23.4%), Pedestrian vs. MVA (3.5%), Other (3.7%) and information not provided (2.8%). Strict adherence to ACEP guidelines would have lead to the reduction of 155 CT scans. 17/18 patients with TBI would have been detected using only these guidelines. The 1 patient missed by ACEP guidelines had a minimal subdural hematoma, was observed and released without sequelae.  

Our Phase 1 data shows that adhering to existing ACEP guidelines could potentionally reduce screening head CT utilization in the emergent setting without significant loss of sensitivity in minor blunt head injury. Applying ACEP guidelines would have detected 17/18 TBI and reduced CT scans by 155.

With national sentiment to reduce radiation exposure and decrease healthcare costs, maintaining judicial use of imaging is the responsibility of both the radiologist and ordering physicians.

Jung, M, Kelly, M, Griffith, B, Narayan, A, Krupp, S, Vallee, P, Nagarwalla, J, Loeckner, P, Jain, R, Use of Screening Head CT in the Setting of Blunt Head Injury in a Level 1 Trauma Center: Are We Following Clinical Guidelines?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12020912.html